What is iliotibial band syndrome. How does it affect runners and cyclists. What are the main causes and symptoms of ITB syndrome. How is it diagnosed and treated. Which home remedies can help alleviate pain and swelling. When should you seek medical attention for ITB syndrome.

Understanding Iliotibial Band Syndrome: An Overview

Iliotibial band syndrome (ITBS) is a common overuse injury that affects many athletes, particularly runners and cyclists. The condition occurs when the iliotibial band, a thick tendon that runs along the outside of the leg from the hip to just below the knee, becomes irritated and inflamed due to repetitive friction against the bone.

The iliotibial band plays a crucial role in stabilizing the knee during physical activities. When it becomes overworked or tight, it can lead to pain and discomfort, significantly impacting an individual’s ability to perform their usual activities.

Anatomy of the Iliotibial Band: From Hip to Knee

To better understand ITBS, it’s essential to grasp the anatomy of the iliotibial band:

• The iliotibial band is a thick, fibrous tissue that extends from the iliac crest of the pelvis to the lateral condyle of the tibia.
• It functions as a lateral knee stabilizer and assists in hip abduction.
• A fluid-filled sac called a bursa is located between the bone and the tendon, providing lubrication and reducing friction.

When the iliotibial band repeatedly rubs against the bone, it can cause inflammation of the bursa, the tendon, or both, leading to the characteristic pain associated with ITBS.

Common Causes and Risk Factors for Iliotibial Band Syndrome

Several factors can contribute to the development of ITBS:

1. Repetitive activities: Running and cycling, which involve repeated knee bending, are primary culprits.
2. Poor physical conditioning: Weak muscles and lack of flexibility can increase the risk.
3. Tight iliotibial band: Natural tightness or inadequate stretching can lead to increased friction.
4. Improper form during activities: Poor technique can put additional stress on the ITB.
5. Insufficient warm-up: Failing to prepare the muscles and tendons for activity can increase the risk of injury.
6. Anatomical factors: Bowed legs or other structural abnormalities can contribute to ITBS.
7. Sudden changes in activity levels: Rapid increases in training intensity or duration can overload the ITB.
8. Core muscle imbalances: Weakness in the core muscles can affect overall biomechanics.
9. Previous injuries: A contusion or bruise in the area can make the ITB more susceptible to irritation.

Recognizing the Symptoms of Iliotibial Band Syndrome

Identifying the symptoms of ITBS is crucial for early intervention and effective treatment. The most common signs include:

• Pain on the outside of the knee or hip, typically starting mild and worsening over time
• Discomfort that initially subsides during warm-up but returns and intensifies with continued activity
• Increased pain when running downhill or sitting for extended periods with the knee bent
• A burning sensation along the outside of the thigh or knee
• Occasional swelling around the affected area

Can symptoms vary in severity? Indeed, the intensity of ITBS symptoms can range from a mild ache to severe pain that limits physical activity. Some individuals may experience a clicking sensation as the ITB moves over the lateral femoral epicondyle during knee flexion and extension.

Diagnosis and Medical Evaluation of Iliotibial Band Syndrome

Diagnosing ITBS typically involves a combination of physical examination and patient history. Healthcare providers will often:

1. Conduct a thorough physical examination, assessing the range of motion and looking for areas of tenderness
2. Perform specific tests, such as the Noble compression test or Ober’s test, to evaluate ITB tightness
3. Review the patient’s activity history and recent changes in training or exercise routines
4. Consider the patient’s description of symptoms and their onset

In most cases, imaging tests are not necessary for diagnosis. However, if there’s uncertainty or a need to rule out other conditions, the following may be recommended:

• Ultrasound: To visualize soft tissue inflammation
• MRI (Magnetic Resonance Imaging): For a detailed view of the ITB and surrounding structures

Is a professional diagnosis always necessary? While self-diagnosis is possible for experienced athletes, seeking professional medical advice is crucial for accurate diagnosis and appropriate treatment, especially if symptoms persist or worsen.

Comprehensive Treatment Approaches for Iliotibial Band Syndrome

Treatment for ITBS typically involves a multifaceted approach, combining various strategies to reduce pain, promote healing, and prevent recurrence:

Conservative Treatment Options

• Rest and activity modification: Reducing or temporarily ceasing activities that exacerbate symptoms
• Ice therapy: Applying ice to the affected area for 15 minutes every 2-3 hours to reduce inflammation
• Anti-inflammatory medications: Over-the-counter NSAIDs like ibuprofen or naproxen to manage pain and swelling
• Stretching exercises: Targeted stretches to improve flexibility of the ITB and surrounding muscles
• Strengthening exercises: Focus on hip abductors, core muscles, and other stabilizing muscle groups
• Foam rolling: Self-myofascial release techniques to alleviate tension in the ITB

Advanced Treatment Modalities

For cases that don’t respond to conservative measures, additional treatments may include:

• Physical therapy: Customized exercise programs and manual therapy techniques
• Corticosteroid injections: To provide targeted relief for severe inflammation
• Orthotics: Custom shoe inserts to correct biomechanical issues
• Gait analysis and retraining: To identify and correct movement patterns that contribute to ITBS

How long does recovery from ITBS typically take? Recovery time varies depending on the severity of the condition and adherence to treatment, but most individuals see improvement within 4-8 weeks of consistent management.

Surgical Interventions: When Conservative Treatments Fall Short

While surgery is rarely necessary for ITBS, it may be considered in chronic cases that don’t respond to conservative treatments. Surgical options include:

1. ITB release: Lengthening the iliotibial band to reduce tension and friction
2. Bursectomy: Removal of the inflamed bursa
3. Partial ITB resection: Removing a portion of the irritated tissue

Surgical interventions are typically performed arthroscopically, allowing for smaller incisions and faster recovery times. However, the decision to undergo surgery should be made carefully, considering all alternative options and potential outcomes.

What is the success rate of surgical interventions for ITBS? While success rates can vary, studies have shown that approximately 80-90% of patients experience significant improvement following surgical treatment for recalcitrant ITBS.

Home Remedies and Self-Care Strategies for Managing ITBS

In addition to professional treatment, there are several self-care measures individuals can employ to manage ITBS symptoms and promote recovery:

• Apply heat before exercise to warm up the tissues and improve flexibility
• Use ice after activity to reduce inflammation and pain
• Wear a compression sleeve or knee brace during activities to provide support and warmth
• Gradually return to activities, starting with shorter distances or lower intensity
• Incorporate cross-training activities that don’t aggravate the ITB, such as swimming or cycling (if running is the primary issue)
• Maintain proper hydration and nutrition to support tissue healing
• Ensure adequate rest between workouts to allow for recovery

Can dietary changes help in managing ITBS? While not directly related to the condition, a balanced diet rich in anti-inflammatory foods and nutrients that support connective tissue health (such as omega-3 fatty acids, vitamin C, and collagen) may contribute to overall recovery and tissue resilience.

Prevention Strategies: Keeping Iliotibial Band Syndrome at Bay

Preventing ITBS is often easier than treating it. Here are some effective strategies to reduce the risk of developing this condition:

1. Implement a proper warm-up routine before exercise
2. Gradually increase training intensity and duration (follow the 10% rule)
3. Incorporate regular stretching and strengthening exercises for the lower body and core
4. Ensure proper footwear that provides adequate support and is appropriate for your activity
5. Address any biomechanical issues or muscle imbalances through targeted exercises or professional guidance
6. Vary your training surfaces and avoid excessive downhill running
7. Listen to your body and allow for adequate rest and recovery between workouts

How often should preventive exercises be performed? Ideally, incorporate ITB-specific stretches and strengthening exercises into your routine 2-3 times per week, even when not experiencing symptoms, to maintain flexibility and strength.

When to Seek Medical Attention for Iliotibial Band Syndrome

While many cases of ITBS can be managed with self-care and conservative treatments, there are instances where professional medical attention is necessary. Consider consulting a healthcare provider if:

• Pain persists or worsens despite rest and home remedies
• Symptoms interfere with daily activities or sleep
• You experience sudden, severe pain or swelling in the affected area
• There’s noticeable warmth or redness around the outside of the knee or hip
• You’re unsure about the cause of your symptoms or suspect a different underlying condition

Early intervention can prevent the condition from becoming chronic and help you return to your normal activities more quickly. A healthcare professional can provide a comprehensive evaluation, accurate diagnosis, and tailored treatment plan to address your specific needs.

What questions should you prepare for your medical appointment? Be ready to discuss your symptom history, activity levels, any recent changes in training, and previous treatments you’ve tried. This information will help your healthcare provider make an informed decision about your care.

Long-Term Outlook and Management of Iliotibial Band Syndrome

The prognosis for ITBS is generally favorable, with most individuals responding well to conservative treatment and preventive measures. However, it’s important to understand that recovery may take time and require patience and consistency in following treatment recommendations.

Long-term management of ITBS often involves:

• Ongoing attention to proper form and biomechanics during physical activities
• Regular incorporation of stretching and strengthening exercises into fitness routines
• Periodic reassessment of training practices and equipment
• Awareness of early warning signs and prompt action to prevent recurrence

Can ITBS recur after successful treatment? Yes, recurrence is possible, especially if underlying factors such as biomechanical issues or training errors are not adequately addressed. Maintaining good habits and staying vigilant about prevention strategies can significantly reduce the risk of recurrence.

By understanding the nature of iliotibial band syndrome, recognizing its symptoms, and implementing appropriate treatment and prevention strategies, individuals can effectively manage this condition and maintain an active, healthy lifestyle. Remember that each case is unique, and working closely with healthcare professionals can ensure the best possible outcomes for those affected by ITBS.

Iliotibial band syndrome – aftercare: MedlinePlus Medical Encyclopedia

The iliotibial band (ITB) is a tendon that runs along the outside of your leg. It connects from the top of your pelvic bone to just below your knee. A tendon is thick elastic tissue that connects muscle to bone.

Iliotibial band syndrome occurs when the ITB becomes swollen and irritated from rubbing against the bone on the outside of your hip or knee.

There is a fluid-filled sac, called a bursa, between the bone and the tendon on the outside part of your leg. The sac provides lubrication between the tendon and the bone. The rubbing of the tendon can cause pain and swelling of the bursa, the tendon, or both.

This injury often affects runners and cyclists. Bending the knee over and over during these activities can create irritation and swelling of the tendon.

Other causes include:

• Being in poor physical condition
• Having a tight ITB
• Poor form with your activities
• Not warming up before exercising
• Having bowed legs
• Changes in activity levels
• Imbalance of the core muscles
• Injury to the area like a contusion or bruise

If you have ITB syndrome you may notice:

• Mild pain on the outside of your knee or hip when you begin to exercise, which goes away as you warm up.
• Over time, the pain feels worse and doesn’t go away during exercise.
• Running down hills or sitting for a long time with your knee bent may make pain worse.

Your doctor will examine your knee and move your leg in different positions to see if your ITB is tight. Usually, ITB syndrome can be diagnosed from the exam and your description of the symptoms.

If imaging tests are needed, they may include any of the following:

• Ultrasound
• MRI

If you have ITB syndrome, treatment may involve any of the following:

• Medicines or applying ice to relieve pain
• Stretching and strengthening exercises
• A shot of medicine called cortisone in the painful area to relieve pain and swelling

Most people do not need surgery. But if other treatments do not work, surgery may be recommended. During surgery, part of your ITB, the bursa, or both will be removed. Or, the ITB will be lengthened. This prevents the ITB from rubbing against the bone at the side of your knee.

At home, follow these measures to help reduce pain and swelling:

• Apply ice to the painful area for 15 minutes every 2 to 3 hours. Do not apply ice directly to your skin. Wrap the ice in a clean cloth first.
• Apply mild heat before stretching or doing strengthening exercises.
• Take pain medicine if you need to.

For pain, you can use ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn), or acetaminophen (Tylenol). You can buy these pain medicines at the store.

• Talk with your doctor before using any pain medicines if you have heart disease, high blood pressure, kidney disease, or have had stomach ulcers or internal bleeding in the past.
• Do not take more than the amount recommended on the bottle or by your doctor.

Try running or cycling shorter distances than you usually do. If you still have pain, avoid these activities completely. You may need to do other exercises that do not irritate your ITB, such as swimming.

Try wearing a knee sleeve to keep the bursa and ITB warm while you exercise.

Your doctor may recommend a physical therapist (PT) to work with your specific injury so you can return to normal activity as soon as possible.

Your PT may recommend ways to change how you exercise to prevent problems. Exercises are aimed at strengthening your core and hip muscles. It will also focus on stretching your tissue to allow less irritation. You may also be fitted for arch supports (orthotics) to wear in your shoes.

Once you can do stretching and strengthening exercises without pain, you can gradually begin running or cycling again. Slowly build up distance and speed.

Your PT may give you exercises to do to help stretch your ITB and strengthen your leg muscles. Before and after activity:

• Use a heating pad on your knee to warm the area up. Make sure the pad’s setting is on low or medium.
• Ice your knee and take pain medicine after activity if you feel pain.

The best way for the tendons to heal is to stick to a care plan. The more you rest and practice physical therapy, the quicker and better your injury will heal.

Call your health care provider if pain gets worse or does not get better in a few weeks.

IT band syndrome – aftercare; ITB syndrome – aftercare; Iliotibial band friction syndrome – aftercare

Akuthota V, Stilp SK, Lento P, Gonzalez P, Putnam AR. Iliotibial band syndrome. In: Frontera WR, Silver JK, Rizzo TD Jr, eds. Essentials of Physical Medicine and Rehabilitation: Musculoskeletal Disorders, Pain, and Rehabilitation. 4th ed. Philadelphia, PA: Elsevier; 2019:chap 69.

Huntoon E, Dec KL, Caldwell M. Lower limb pain and dysfunction. In: Cifu DX, ed. Braddom’s Physical Medicine & Rehabilitation. 6th ed. Philadelphia, PA: Elsevier; 2021:chap 36.

Riff AJ, Chalmers PN, Bach BR. Knee diagnosis and decision-making. In: Miller MD, Thompson SR, eds. DeLee, Drez, & Miller’s Orthopaedic Sports Medicine: Principles and Practice. 5th ed. Philadelphia, PA: Elsevier; 2020:chap 90.

Updated by: C. Benjamin Ma, MD, Professor, Chief, Sports Medicine and Shoulder Service, UCSF Department of Orthopaedic Surgery, San Francisco, CA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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Causes of outer hip pain: Symptoms, treatment, and prevention

Lateral hip pain is pain that affects the outer side of the hip. Pain in this area can develop suddenly or gradually.

Both injury and overuse can cause pain in the outer hip area. People use their hips constantly while walking, sitting, and moving throughout the day. As a result, hip pain is a common problem.

While outer hip pain may sometimes go away on its own, other cases require the help of a medical professional.

In this article, we look at some of the causes of outer hip pain, as well as treatment and prevention strategies.

Share on PinterestOuter hip pain is often due to bursitis or tendonitis, but there are several other possible causes.

Hip pain on the outside of the hip usually occurs because of an issue with one of the following:

• tendons
• bursa — a fluid filled sac that helps cushion certain bones
• muscles
• cartilage

These tissues surround the hip joint. Any of them can wear down or become inflamed and cause pain. Bursitis and tendonitis, both overuse injuries, are very common causes of outer hip pain.

Hip pain, including outer hip pain, is common in athletes. Athletes who participate in activities such as running, soccer, and dancing are at risk for hip injuries. However, hip pain can affect people of all ages and activity levels.

Common causes include:

Bursitis

A bursa is a small sac containing fluid. Bursae help cushion and reduce friction between a bone and the overlying soft tissues.

Bursitis is a condition in which the bursa becomes inflamed and irritated.

Trochanteric bursitis involves the bursa that covers the outer aspect of the hip bone. The bursa becomes inflamed, resulting in pain that radiates to the outer thigh.

Learn more about bursitis here.

Tendonitis

A tendon is an anatomic structure that connects a muscle to a bone. Tendonitis is a condition that occurs when a tendon becomes inflamed.

A tear in the gluteus medius tendon can also cause outer hip pain. The gluteus medius is the muscle that goes from the buttocks to the hip bone and allows a person to lift their leg to the side.

Injury, overuse, and general wear and tear can lead to gluteus medius tendonitis, a tear in the tendon, or both. Both conditions can cause pain in the outer hip area and, in severe cases, weakness of the hip.

Learn more about tendonitis here.

Other causes

Other causes of outer hip pain include:

• Osteoarthritis: Osteoarthritis is the most common type of arthritis. It is more likely to affect people over the age of 50 years, particularly females.
• Obesity: Carrying a higher amount of body weight places more pressure on the joints in the lower body. Fat cells also promote inflammation. These factors may lead to hip pain or conditions such as osteoarthritis.
• Injury: A traumatic injury, whether from a fall or other accident, can cause outer hip pain.
• Femoroacetabular impingement (FAI): A condition in which the hip joint is unable to move freely. FAI affects the hip’s normal range of motion.
• Referred back pain: A lower back problem may cause pain to radiate to the outer hip, as well as the buttocks, the back of the leg, and, sometimes, the front of the hip.

Certain activities can aggravate hip pain, including:

• lying on the side of the body
• crossing the legs
• sitting down, especially if people tuck their feet underneath them
• standing or leaning on one leg
• walking uphill or up the stairs
• climbing in or out of a car or bath

A doctor will perform a physical exam to determine the cause of outer hip pain. They may also order one or more diagnostic tests.

These tests may include:

• X-rays
• CT scan
• MRI scan
• blood tests to check for infection or rheumatoid arthritis

People should seek medical attention if their hip pain is the result of a severe injury.

A doctor can help diagnose and treat the issue if the pain does not go away, gets worse, or begins to affect regular activities and sleep.

A doctor should also evaluate pain that spreads to other areas, such as the lower back.

People with pain that does not ease after 2 weeks of taking NSAIDs should make an appointment with a doctor to find alternative forms of relief.

Anyone who finds that stretching and strengthening exercises cause soreness that lasts longer than a few days should also see a doctor.

Treating the underlying cause of outer hip pain, such as injury or infection, can help treat the pain.

Aging can also cause various aches and pains, including outer hip pain. However, hip pain should not have a negative effect on a person’s regular daily activities.

Strategies and treatment options are available for people with outer hip pain. Total relief from all pain, however, may take some time.

People may be able to avoid reoccurring outer hip pain by:

• allowing adequate rest and recovery after rigorous physical activity
• losing weight, if appropriate
• sticking to a strengthening and stretching program
• wearing flat shoes and proper footwear for exercise

Outer hip pain, which often results from overuse, can be uncomfortable and even debilitating. Sometimes, the pain is enough to prevent everyday activities and disturb sleep.

It can be difficult to rest the affected hip completely, but limiting vigorous exercise and avoiding movements that cause pain can aid the healing process.

If pain persists beyond 2 weeks, a person should consult a doctor. They can diagnose the cause of the outer hip pain and find the right treatment plan.

REFLEX ZONES

Reflex zones associated with the spine

For the labor potential of most countries, back pain is the cause of the annual loss of millions of man-days. There is nothing unexpected in this – after all, the spine is the main part of the skeleton, so any violation of its function inevitably leads to a deterioration in the state of the human body as a whole.

The reflex zones corresponding to the spine are located along the inner edges of the soles of both feet, on the line connecting the inside of the heel to the base of the big toe. You can identify all points of hypersensitivity that lie on this line, for this you should massage the area along this line with your fingers. Having found a point of hypersensitivity, it must be properly kneaded. The upper end of the line of biologically active points, that is, the point lying at the base of the big toe, corresponds to the section of the spine at shoulder level.

Treatment of dysfunctions of the spine with reflexotherapy

In case of such troubles with the back as lumbago (lumbago), one should massage not only the biologically active points associated with the spine, but also the points associated with the brain and the endocrine system. Since the muscles are both an addition and a “counterweight” to the bones of the skeleton and are involved in all movements made by a person, it is also necessary to stimulate the muscles in case of back pain. You should massage the muscles, if possible, deeply immersing your fingers in them. After finishing the massage of one muscle group, you need to switch to another.

Back pain can be caused by poor posture, excessive tension in one or another muscle group, or flat feet. It is necessary to take into account all possible causes of pain and perceive the problem not as a combination of various symptoms, but as a whole. Exercise and walking are particularly beneficial for relieving back pain, as physical activity develops and strengthens a variety of muscle groups. Fast walking usually has no contraindications, but running is not always useful and can even exacerbate some diseases.

To reduce pain in the back, in particular, in the lower half of the back, reflexology often affects the muscles of the legs. The muscles located on the back of the thigh should be massaged, usually such a massage is carried out by alternately pressing and pinching with the fingers of both hands. The entire thigh area should be treated – from the border with the buttock to the inside of the knee. Perform such a massage on both legs, paying special attention to tense muscles, and you will feel that the back pain goes away, and the general condition of the body has improved significantly.

After examining pictures 1, 2, 3, 4, 5, 6, you can find that there are many biologically active points on the hands and feet associated with the shoulders, hips and neck. When working on general disorders of the musculoskeletal system, it is useful to perform a thorough massage of areas related to such parts of the body as the neck and shoulders, as well as to stimulate pressure points on the brain, solar plexus, endocrine system, various parts of the skeleton, endocrine glands, etc. e. For the treatment of conditions such as bursitis (inflammation of the joint), joint pain, constant tension of the neck muscles, etc. , a general reflexotherapy massage should be performed, which should include stimulation of biologically active points corresponding to various parts of the skeleton, and also nervous, endocrine, digestive and circulatory systems. Usually, this or that disorder should be treated with a combination of stimulation of biologically active points corresponding to the diseased organ, and points associated with the vital activity of the organism as a whole. It should be remembered that in some cases, surgical intervention is unavoidable – for example, when implantation of an artificial hip joint is required.

Figure 1.
Reflex zones on the outer side of the foot
Biologically active areas located on the inside of the foot

Figure 3.
The main reflex zones located on the palm of the left hand0027 Figure 4.
Main reflex zones located on the palm of the right hand

3 Reflex zones located on the back of the hand

Figure 6
Reflex zones located on the back of the hand

The knee joint is often the source of pain and discomfort. In such conditions, it is useful to apply pressure with the thumb and middle fingers on the lateral surfaces of the knee joint, on the points located at the end of the femur. This effect should last a few seconds, while gradually increasing the pressure (however, do not allow pain to occur). Repeat the same steps for the points located at the beginning of the tibia, about two centimeters below the first pair of points.

Treatment of arthritis with reflexology

Arthritis is a very common disease of the joints or spine, which manifests itself in their inflammation. Symptoms of arthritis include pain, swelling, limited movement of the joint, and redness of the surrounding skin. The most common types of arthritis are osteoarthritis and rheumatoid arthritis.

Osteoarthritis affects the cartilage that is part of the joint and adjacent bones. Often the cartilage is destroyed, and in its place there are bone formations called osteophytes. Such formations complicate the work of the joint and cause severe pain.

Rheumatoid arthritis is the second most common form of arthritis (after osteoarthritis). This type of arthritis most commonly affects the feet, ankles, wrists, and fingers, with joint swelling and inflammation of the bursae (webbed lining of the joint). All this can lead to the destruction of cartilage and bones of the joint, and sometimes to its complete dysfunction.

Treatment of osteoarthritis and rheumatoid arthritis with reflexotherapy

In the development of the described diseases, it is necessary to perform massage of biologically active points associated with the affected areas. We remind you that in order to speed up the healing process, you should also stimulate the reflex zones associated with the vital activity of the whole organism. Particular attention should be paid to stimulation of the endocrine system.

In search of treatments for rheumatoid arthritis, doctors have found that the use of the hormone cortisone, produced by the adrenal glands of animals, greatly alleviates the course of this disease, but this relief is very short-lived. In addition, cortisone has been associated with various side effects, including muscle and bone damage, stomach ulcers and bleeding, and disturbances in the nervous system and hormone-producing glands. Thus, drug treatment with cortisone is undesirable, but do not forget that this hormone is also produced by the adrenal glands themselves, namely their cortical layer. If we force our own adrenal glands to increase the production of this hormone, then there will be no question of any side effects in this case. This can be achieved with the help of reflexology. In the lower back, between the first and second lumbar vertebrae, about five centimeters above the coccyx, there is a biologically active area, the stimulation of which is very useful for arthritis. Massaging this area greatly alleviates the course of rheumatoid arthritis. For proper stimulation of this area, you should place your finger on the detected painful point and gradually increase the pressure on it for several seconds. This action must be repeated several times. In addition to rheumatoid arthritis, massage of this point is also useful for diseases such as asthma and bursitis.

As with back pain, arthritis should be treated by stimulating the muscles adjacent to the affected joint. Muscle massage is performed by applying pressure on them with the fingers, while moving perpendicular to the direction of the muscle fibers and trying to immerse the fingers as deep as possible into the muscle tissue. At first, this can cause discomfort and burning in the muscles, but after a while, the discomfort will pass. This technique is regarded by many specialists in the field of reflexology as very effective.

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