New Training Device — The CrossRope (Elite Jump Rope System)

If you have been a user of my workouts for any of the past 15 years, you will notice I do not do jump roping as part of my written programming.  It does not mean I disapprove of jumping rope, in fact, I have many years of jumping rope when I wrestled and played football in high school and played rugby in college. We also used jump ropes while on deployments when visiting on submarines or boats when in the SEAL Teams.  I just never pushed jump roping as a training option when the focus of my writing has been mainly running, rucking, swimming as a cardio foundation.

However, after learning about this new jump rope called the Crossrope (www​.crossrope​.com) at the National Strength and Conditioning Association’s Tactical Strength and Conditioning Conference, I actually have added jump roping to my training programs.

The unique design of the handles makes this jump rope system versatile like no other.  The detachable, ball-​​bearing handles offer a smooth speed and rotation of any size rope. Connect the Speed cable for max double under performance, traditional cardio or high speed, high intensity workouts. Then clip in your explode cable to really condition and tone your upper body. Then add the three pound Titan cable and see how many jumps you can get in 1 minute.  The record on the site’s competition videos show people getting hundreds of jumps /​ double unders and other complex challenges with a rope.  With CrossRope, you can easily change the weight of your jump rope by snapping in one of seven different weights of rope. These ropes and handles will help increase your strength, coordination, and fitness quicker and more effectively.  The ball bearing handles ensure that the heaviest rope rotates as smoothly as the lightest so these ropes will spin as fast as you can move them!

The creator of Crossrope is Dave Hunt a Naval Academy graduate and pilot who launched Crossrope in 2012.  This is a new system that will change the way people train and think about jump ropes.  It has changed the way I train.  In the workout below, we used the Titan Heavy Rope /​ Handles and strive to get 100–120 jumps per minute as one element of our circuit below.  See how we mix the Crossrope, Pullups, Kettlebells, TRXs, Sandbags, and Running (then swimming) all into a challenging circuit video.  Here is how we added these ropes to our workout circuits:

Repeat 4–5 times
Max Pullups
1 min TRX Atomic Pushups
1 min TRX Rollouts
1 min Cross Rope Titan
Run with Sandbag 1/​4 mile

*One guy will skip all the above but constantly move a Kettlebell during the time it takes to do this circuit — roughly 6–7 minutes.  Everyone will do the KB swings, snatch, walk etc only 1 round of 6–7 minutes — no resting…

After this we went swimming and practiced treading water in between sets.  We tried jump ropes once on the pool deck but after a few toes getting hit with the rope we added shoes.  OUCH!

We will be developing new workouts with these jump ropes and monitoring the progress.  Already after a few short weeks, everyone in the group are better jump ropers and pushing the limits of their abilities in a new way we have not tried.   So check out CrossRope​.com and see the insane jump rope videos of how well you can progress with this device.

Who knows?  It could become your favorite form of cardio training.

Training in the Heat of the Summer — Any Tips?

Training in the summer months takes some special consideration especially if you live in a hot and humid environment like the South,  East Coast and Midwest.  However, training in arid and hot environments like the Southwest and Western U.S. require the same considerations.  Dryer climates can actually be more dangerous as you do not sweat to stay cool  (it just evaporates almost instantly) — but you will notice salt stains on clothing just the same.

Here is a question from a trainer down in Charleston, who needed some ideas other than the typical “stay well hydrated, avoid the heat of the day, etc…”

Stew,    I train mostly fighters.    I believe outdoor training-​​pt and running /​ rucking for regular marines gets red flagged here around 92 degrees F.  Do you have any thoughts on training in the heat for elite athletes, like SEALs or Marine Force Recon.  My question is limited to upper limits of training in the heat. I train athletes, all kinds, for max performance, and then some for specific conditions, like altitude or heat as an event approaches.  I don’t want a fighter overwhelmed by heat in the ring or on the field– but I want them performing like they trained in ideal conditions.  Any advice?

I have found through experience and studies that half of fatigue is related to body heat so if you can keep the fighter’s body heat down the better they will be no matter what the temperature is outside.  We train year round but in the Summer we get most of our workouts done in the early AM so it is always bearable on the heat scale but we do a few acclimatizing workouts in the later day to get used to 90+ degrees.  Eventually, if you do it right, your fighters will say, ” Hey it is only going to be 89 degrees today, better bring a sweater.”  I used to think the SEAL instructors were just putting us in the water as part of the cold water torture program to get us to quit, BUT I remember so many times that after a long beach run in the heat of the day, that getting into the cold Pacific Ocean was reinvigorating once we were finished.  It did not seem like Surf Torture then.

As you know hydration is the key  before, during and after.  And when profusely sweating (or producing salt stains) you need the salts (electrolytes) even more that normal. Sweating is the key to staying cool BUT if in arid environments or humid as well you need to get them soaking wet in a pool, lake, river, water hose — that really helps too and almost gives the students a second wind.

We typically will workout in the heat — feel completely burned out and very hot then jump in the pool to start a swim workout.  After about 3–4 minutes of cooling down all members are ready to go again almost as if they were fresh and did not get hot prior.  Like I said — half of fatigue is body heat.  Stay cool, hydrated, well-​​fueled and you can go all day.

So our heat busting workouts look like this:

Limit time to one hour in the heat /​ humidity finding shade as much as possible to do PT /​ water breaks etc.

My Spec Ops groups and I will typically run 5–6 miles with mixed in calisthenics of pullups, pushups, abs, squats for that 45–60 minutes.  Then go to the pool and continue with swim PT.

Hydrate /​ electrolytes /​ carbs can be added now — jump in the pool and cool down 4–5 minutes.

Typical Swim PT Workout:
Repeat 10–15 times
100m swim
pushups 20–30
plank pose for remainder of 2 min pushup set
rest with abs of choice 1 min

Prior to getting in the water we do not feel like doing part two of this workout BUT after that pool cool down it really helps.

So in a nutshell, keep them cool with some form of water not just drinking water but some form of getting soaked water methods.  When you can, PT in the shade.  Start harder workouts in the early morning, but as the group gets used to the morning heat, push to later in the morning and into the early afternoon.  Always follow hot workouts with a way to completely soak your body and find a way to cool down.

Special Consideration for air quality.  Often in the heat of the day if the smog pollution level /​ ozone levels are high, it can actually be harmful to train in the bad air.  Upper respiratory infections can quickly follow as “they say” it is like smoking a pack of cigarettes when you run in poor air quality so it depends on your geographical location as well.

One Mile Ocean Swims in Military Training

There are many military training programs that you would assume you have to pass a mile swim as one of the regular fitness tests.  For instance, Navy SEALs, Air Force PJ, Navy Divers /​ EOD, Navy SWCC, Coast Guard Rescue Swimmer, Navy SAR Swimmer, Marine RECON, Army Combat Divers, and I am sure there are others who have to endure the one or more mile swim test.  But a doctor recently asked about a one mile swim test he is training for when he goes to Navy Flight Surgeon school.  Guess what?  They have to pass a one mile swim test wearing their flight suit!  I guess you learn something everyday.

Here is his email:  Stew, I’m a family physician in the navy. I’m applying for the flight surgeon course and one of the requirements is a one mile swim test in flight suit.  I’m a decent swimmer but I don’t have a good plan to prep for this. Would you have any suggestions?

This is true.  You have to pass a one mile swim test in a flight suit (without boots) but you do have 80 minutes to pass.  The standards are not that tough to pass but getting used to swimming with clothes is a new challenge for most people.

At the Naval Academy our Junior year swim test was the 40 Year Swim wearing our khaki uniform (top /​ pants — no shoes).  It was actually only 40 minutes but to many Midshipmen who did not train, I am sure it felt like 40 years.  We all had to swim 40 minutes without stopping to touch the sides of the pool and you were graded by your distance in 40 minutes.  If you could get a mile in those 40 minutes you got an A for the test.  Here is how we trained for our one mile swim with clothes and I am sure this method will help any flight surgeon student.

By the way, you do know that you also have to take the same test as future Navy SEALs have to take in order to get INTO Flight Surgeon School right?  So part of your workout needs to also be in preparation for the 500yd swim, pushups, situps, pullups, and 1.5 mile timed run just to get INTO training.  See the Navy SEAL articles on the PST on the military​.com article archive for more PST test taking tips.

First — build up to 2000–2500 yards per swim workout with just your swim suit on.  You have to build up a base of swimming of at least a mile obviously.  If you just focus on pacing your swimming so you can maintain a nice, steady pace of a yard per second you will be well ahead of the curve.  So a 500 yd swim should take you 8–9 minutes before you start adding clothing to you swims.

Second — swim with a shirt on (long sleeve).  To start to simulate the drag of the flight suit start swimming with clothing. You will find a long sleeve shirt will slow you down up to 15–20 seconds per 50yd lap.   Build up your endurance by doing 500-​​1000yds of the 2000-​​2500yd swimming workout wearing a shirt.  Once that gets easy, do the entire workout wearing a shirt and practice all your strokes such as breast stroke, side stroke, free style, even back stroke to catch your breath.  The key is to just keep moving even if it is slow and on your back.

Third — add a pair of pants.  It is up to you but you can swim shirtless with a pair of pants or go for the whole deal and put on your flight suit for the first time in water.   Check the rules but if you can roll the sleeves up and roll your pants legs up close to your elbow and knees, you will see a big difference in how you swim.  You do not glide much with clothes on so you do have to put out more and swimming a fast pace becomes a real workout.  Once again find your pace and do a few hundred yard sets and determine your pace that you need to get well under the 80 minute time mark.

In a 50m pool a mile is roughly 15–16 laps so you have 3–4 minutes per lap to take this test and succeed.  So my best advice is to practice long before you go to school both the Navy PST as well as the one mile flight suit swim for the least stressful time.

For more information see:  Official Navy Link

From the Navy Flight Surgeon Site:

Swimming. There are additional physical fitness challenges during API. During the swimming phase, you will be required to swim a mile wearing a flight suit (but no boots) in less than 80 minutes, jump from a fifteen-​​foot tower and then swim approximately 25 yards underwater, demonstrate proficiency in the side, back, breast and crawl strokes, and experience the Helo Dunker multi-​​place underwater escape trainer. You may not progress to the flying phase and graduate until these requirements are met. I advise that you begin a swimming regimen before you arrive, particularly if you are a weak swimmer. We administer a swim check after your arrival to identify any students who might benefit from remedial training. Remember that aerobic fitness does not guarantee swimming expertise! Basic aerobic conditioning and honing your swimming skills will be of great benefit in preparing yourself for the physical requirements of the program. Problem with swimming is the number one reason for training delays for our aeromedical officers. Start practicing now!

Good luck — start swimming with clothes now and this test will be a fun event for you.

Tight Muscles from Work — Need Help on PFT

Here is a great email about how many people feel after a long day of work or sport practices and you have to also prepare for a fitness test in the military or special ops training in your near future.

Stew, I am a specialist in the Texas National Guard and I have an extremely hard time with my APFT. My civilian job involves constant lifting, pushing, pulling etc…of heavy objects, I can feel myself getting stronger but my pushup score is declining during tests. I have increased my workout to try to compensate but it doesn’t seem to be helping. When I perform pushups during the test it feels like I’m fighting my chest and shoulder muscles to move downward.  I’m wondering if the constant heavy workout is affecting my range of motion and making pushups harder for me? Have you ever heard/​encountered this? How can I get my APFT score back up?

Workout Failure — Motivate or Discourage

Every so often I get an email from a future Special Ops student who is preparing for the challenges of some of the toughest training programs in the world (SEALs, Special Forces, AFPJ/​CCT, RECON /​ MarSOC and foreign groups for SAS, SBS, and the Foreign Legion):

Here is the question: Stew, I have been training pretty hard mixing in weights, calisthenics, running, swimming, and a few non-​​impact cardio options for additional heart /​ lungs work. I find myself not keeping up with others in the group or even meeting max repetition /​ faster times standards in the PST.  I am feeling pretty discouraged with the workouts but I stay motivated to train with my buddies.  Any advice?

Tactical Athletes and Nutrition

Here is an article from a friend of mine after having this discussion at a conference a few weeks ago on nutrition for military, police, fire fighters — our tactical athletes.  The need for more carbs for highly active people but it goes deeper than that:

Nutrition and the Tactical Athlete

As a firefighter understands fire, the warrior must understand war. Maintaining combat effectiveness via proper training and nutrition is a big part of this.

Nutrition is the one factor affecting each person multiple times per day and therefore has the greatest impact on a person’s overall health and fitness level. Scientists agree that 70+% of diseases known to man are caused by lifestyle factors and many can be treated via lifestyle changes. Nutrition being the number one approach.

For the tactical /​ endurance athlete this fact does not change. Being fit does not mean being healthy and the level of proper nutrition should address both of these factors.

The level of combat readiness literally translates into life and death. This fact makes the tactical athlete an extreme endurance athlete. Long hours of high stress from limited sleep, MRE’s and massive physical demands provide very unique nutritional demands.

Combat is high stress. The modern day tactical athlete often operates night and day for months without rest. This massive amount of stress not only results in mental breakdown leading to PTSD but also physical breakdown leading to physical injury and less combat effectiveness. This high stress results in elevated cortisol levels. Elevated cortisol causes 3 main problems in the warrior. One, lowered immune functions thus making the warrior more susceptible to illness, two, protein breakdown from muscle to keep blood sugar steady which leads weakness and to number three, increased body fat.

The three issues can be offset with proper nutrition in the field. For years ultra-​​endurance athletes have developed techniques and products for maintaining endurance days on end during a race. Polysaccharide gels, powders and liquids aimed at keeping blood sugar levels steady along with hydration and electrolyte balance are the key. A tactical athlete must maintain steady blood sugar, water and electrolyte balance. MRE’s do not do this and often have the reverse effect of maintaining combat readiness.

How does a tactical athlete maintain steady blood sugar? First, start by figuring your personal caloric needs. Google is full of BMR calculators. Second, plan to eat 65–70% of your diet from a polysaccharide source. (whole grains, sweet potatoes, brown rice, beans). Third, calculate your caloric intake of starchy carbs. 1 gram of carbs is 4 calories. Finally, use an online resource to calculate the carbohydrate intake from your food.

Example: BMR = 2000cals per day. Add 600 calories per day for moderate activity levels = 2600 calories per day consumed. 2600 x .65% of carbohydrate = 1690 calories from starchy sources. Each gram is 4 calories, 1690 /​ 4 = 423 grams of carbohydrate consumed per day. Finally to calculate how much carbohydrate is in the food you eat I suggest the online resource myfitnesspal​.com.

There is much more to understand regarding nutrition. But, much like a firefighter studies and understands fire those whom wish to become or are tactical athletes must study and understand nutrition. We will further expand on this topic in the next edition.

Dr. Stephen Erle is the training director for the civilian BUD/​s program, SEAL Training Adventures, as well as the Strength and Conditioning Coach and team physician for a Virginia University. In addition Dr. Erle instructs tactical athletics, sports medicine, sports nutrition and tactical combat casualty care medicine (TCCC). He can be reached for comment at Steve@​SEALTrainingAdventures.​com.

De-​​Stressing Routine for Anyone

Here is an email from a security officer I have known for a few years who primarily does personal security details nearly everyday of the week.

Stew, I am trying to get back into workouts but with 18–20 hour travelling security details, I barely have time to sleep before I am up again preparing for the next day.  This last month has been brutal with travel, daily security details, and eating like crap.  I am ready to turn this around and start working out hard again. What do you recommend and where should I start?

Have you ever heard the phrase, ” Your nerves are shot?”  Basically you are over stressed and need to focus on the basics right now.  Truly though, your central nervous system takes a beating when you are not sleeping well and having long stressful work days which can negatively impact your personal life (thus more stress), and not eating right.

Tactical Fitness and Special Ops Training

Hey Stew, I am working on a project and was curious what your opinion on today’s warrior and Special Ops fitness and which training disciplines best achieve this?

Great question!  Over the past decade Special Ops Fitness has morphed into a new fitness genre along with military, police, and fire fighter fitness called Tactical Fitness.  In fact, the National Strength and Conditioning Association has created the Tactical Strength and Conditioning Certification Program and hold some of the best conferences I have ever been to.  Speakers include those physiologists and athletic trainers who train active duty Special Ops Team such as Delta Force and SEAL Team Six.  But the real progress in training is in the Army, Marines, Navy, Air Force, FBI, Border Patrol, and other federal law enforcement programs.  Now many of our nation’s branches of service are hiring sports team trainers to run their indoctrination (boot camp), special operations maintenance and injury /​ rehabilitation programs for instance.

Questions /​ Answers on Fitness Basics — Things to Consider

Good questions with answers below…

(1) How long is a workout? Should it be a half-​​hour or a full hour?

Depends on your goals and current fitness level. 30 min is great for a beginner /​ maintenance plan or high intense workout. 60+ min is needed for longer events like marathons, triathlons, spec ops training, but fine for a body building workout. Like I said — all depends…

Mine are usually 2–3 hours long full of calisthenics, running, swimming mix in the summer and shorter with weights and light cardio in the winter — see how

To Paleo or Not to Paleo: The Pro’s and Con’s of the Paleo Diet

Here is an interesting discussion topic on the Paleo Diet. Many love it — some hate it. Decide for yourself…

Over the past few years, I have been asked about the Paleo Diet Plan.  Having not tried it myself and only reading reviews by critics and previews from the authors, I did not have enough information to make a good judgment on the Paleo Plan.  After researching information for a recent article on Health Screenings for Military​.com, I met with several doctors and the author of The Paleo Solution, Robb Wolf and have found the Paleo Diet to be a viable solution for many people (typical Americans) but it may not be for everybody.  This article gives some of the PROs and CONs of the Paleo Diet.

AF PAST — Test Taking Tips (Transitions)

Here is an email from an active duty airman who is training /​ trying out for the AF Para-​​rescue program (AFPJ). He is having issues with his running portion of the PAST which is arranged after the 500m swim.

I have been doing PAST workouts for several weeks. So far, I have done a practice PAST every Monday for the Past 4 weeks, today being the fourth one, and the running seems to kill me every time. The scheduled PAST that I have officially coming up is during the last week of March, somewhere between March 25–29.

It could be your transition or you need a better recovery program. Can you run well normally without the swim first? Perhaps you need to train for your transitions and do more swim — runs and read:

Training for Army Special Forces with the GoRuck Challenge

There are many military related fitness events these days.  The GoRuck programs teach valuable lessons such as team work, persistence, and require a never quit attitude pulled from an untapped reservoir of your own mental toughness.  These can be great schools for your own personal growth, a corporate team building exercise, or actual Special Ops preparation.  The GoRuck Challenge (www​.goruckchallenge​.com) is one of those events taught by former Army Special Forces soldiers than can teach you to engage your mental toughness through a challenging 10–12 hour event.  The cadre have performed hundreds of these 10–12 hour Challenges all over the world.  The highly professional cadre let you see a city like you never imagined!  Now there are other options for you to progress no matter what fitness level you are:

Go Ruck Light, Go Ruck Challenge, Go Ruck Selection, Go Ruck Heavy.  Each progress logically

Health Screening 101 (Part 3 of 3)

This is article 3 of the 3 part series of Health Screening 101.  The first two articles in the series of Health Screening 101 are the following:

Health Screening 101 – Part 1:  Introduction to Blood Tests /​ Insulin Resistance /​ Cholesterol Education

Health Screening 101 – part 2:  Courses of Action to Follow:  Diet, Exercise, Medications Recommended

In this article, we will discuss the changes in his Health Screening Test after four months of following a Low Carb /​ Paleo diet, an exercise program, and a statin drug.

Health Screening 101 (Part 2 of 3)

Previous Article in the Series:  Health Screening 101: Blood Testing (Part 1)

In this article, we will discuss the recommended courses of action to obtain healthy screening numbers posed to us by an officer with recent blood screening questions.   The goal of the recommendations below is to turn the subject’s next blood test into fewer RED LIGHTS and eventually ALL GREEN LIGHTS.

Exercise, Diet, & Medication Recommendations

An exercise program should help you burn the glucose from your body as well as reduce your fat stores.  To effectively do both, it is recommended that you start off your workout with resistance training (weight training or calisthenics) for 20–30 minutes to burn your blood sugar (glucose) and glycogen first.  The higher your heart rate the more sugar you are using for energy.  This is anaerobic training which requires your body to burn glycogen in order produce energy for the challenging demands of this high intensity exercise.   Follow your anaerobic training with an easy paced, “fat burning”, aerobic training program like walking, jogging, biking, swimming at a pace that you can still hold a conversation but just barely.   See below for a sample full body workout with cardio program:

Health Screening 101 (Part 1 of 3)

Health Screening 101: Blood Testing (Part 1)

Without a better understanding of Health Screening Tests, looking at blood screening paperwork can be both overwhelming as well as invoke attitudes of apathy for borderline healthy /​ unhealthy numbers. Here is an email from an officer who is 33 years old who admits he needs to lose a few pounds, but is concerned with his recent blood work numbers:

Stew, I know you are not a doctor, but can you give me your opinion on these numbers? The left column is my most recent numbers from last week (Nov 2012) and the numbers on the right are the ranges I should be in to be considered healthy. I know I need to eat better, exercise, and get more sleep, but where do I start? Should I be overly-​​concerned and start taking medication to deal with this?

Wow, great question. I too get overwhelmed when I look at all the different blood test elements and ranges when some are good, bad, or borderline. And, yes, I am not a doctor, but I know several and have interviewed them to help me write this response to your questions. But to help demonstrate where you need to focus, we are going to use the TRAFFIC LIGHT System created by Specialty Health in Reno NV, to help drive home the importance and understanding of these scores as everyone thoroughly understands the standard traffic light:

Specific Training of the Tactical Athlete

A question posted about the training of the Tactical Athlete this week sparked some debate and with the help of Dr. Steve Erle, we came up with a very thorough answer.  Nutrition will be addressed in a following post:

THE TACTICAL ATHLETE:  How specifically does a tactical athlete train?

Here are some specifics on the physiology of training, example tactical specific exercises, and design of a tactical athletic program.

The tactical specific program is going to revolve around high capacity for muscular endurance, cardiovascular endurance and elevated cognitive function under high stress, elevated heart rates and often depleted nutrients.

Daily Pushups? Fitness Testing Help Needed!

Here is a good question about performing at a maximum level on fitness testing.  As with weight training, you do not want to do daily high repetition calisthenics on the same muscle groups.  In fact, when you push the limits of 500‑1000 reps in a workout, you could still be pushing it too much still.  See what young hard charger says:

Stew, I used to do 1000 pushups a day and built up to 80 pushups in two minutes.  After reading your article on Stop Doing Daily PT I dropped to 1000 pushups every OTHER day.  I am doing well with everything else (pullups, situps, run, and swim) but cannot get over 100 pushups on the PST?  What gives?  

Your problem is pretty common actually.  Even though your volume of pushups is very high, you would think that 100 reps in a two minute period is going to happen sooner than you think.  Well, this increase is tough.  It is like dropping from a 7 minute mile pace to a 6 minute mile pace.  It takes time AND practice with two minute pushups tests.  Also in the Navy SEAL /​ SWCC, EOD Physical Screening Test (PST) you have to swim 500 yards first, so when you do your pushup sets you should mix it with swimming.  For instance do Swim /​ PT like this:

The Spartan 300 Workout and New Variations

Most everyone has heard about the Spartan 300 Workout developed for the actors in the movie 300 by the Gym Jones folks. If you have not seen this or tried it, be warned it is pretty advanced, but you can make your own variations with some creativity as the core of this workout is fantastic.

The 300 is designed like this: Six exercises for 50 reps of each = 300 total reps. Now the original 300 is this specific series of exercises:

Need Help Passing Fitness Test in Two Weeks

Here is a very common email received from a young man seeking to join a local police academy.  He has to pass his PFT in two weeks:

Stew, I have about two weeks until I need to pass my fitness test that will allow me to join the County Police Academy.  I need to increase my bench press by 40 lbs  and drop my 1.5 mile run time by two minutes.  What plan do you have or advice do you have for me?

Wow, I have to be honest, I am not sure there is ANY program out there that will allow for that kind of progress on what I am assuming reaching the minimum standards at best.  So you are likely not at all ready to push yourself at these levels yet.  Simply put — you need more time.  Depending on your current fitness level you might be able to get those goals in two months.

Strengthen Glute Medius to Avoid Common Knee Pain

Here is an article written by a friend of mine who understands common overuse injuries with athletes as well as special operations training programs with regard to knee tendonitis that can shatter a military person’s Special Ops dreams.  Learn how to strengthen the legs /​ hips to help prevent nagging injuries such as Illiotibial Band (ITB) and add some lateral leg movements to your training.

BUD/​s Knee

The most common complaint of pain for a BUD/​s candidate it pain stemming from the Iliotibial Band (ITB, or I Tried BUDs). The ITB starts at the crest of the pelvis above the hip joint and runs to the outside of the knee. Attached to the ITB are the Gluteus Medius, Quadriceps and Hamstring muscles. Common issues with the ITB lead to lateral knee, hip and low back pain. A common issue with tight quads is pain  under the knee cap and tight hams often lead to low back pain.