Iliotibial Band Syndrome
It’s the middle of marathon season and a number of my patients have been limping through the door with pain at the outside of their knee or hip. The most common cause of lateral knee pain in runners is Iliotibial Band Friction Syndrome.
Location and Function
The IT band, and the pain associated with it’s inflammation, is the kink in a runner’s stride. The IT band begins at the external iliac crest (Hip Bone) and ends at the lateral condyle of the tibia (outside of the knee on the lower leg). The IT band stabilizes the knee during the stride and is usually aggravated in individuals who are overtraining, overpronating (rolling on the outside your foot when you walk) in their stride, or have oppositional workout to work habits.
This last little bit is seen in someone who is working at a desk the majority of the day then goes for a long run in the evening. The muscles that are long and stretched when running are short and tight when you are sitting for long periods of time. This is also seen clinically in triathletes that are training for long rides on their bikes and then run. In situations like this stretching throughout the day while at your desk is integral in recovery of IT band pain. In cyclists, making sure your bike is properly fitted so your leg extension is appropriate and your toes do not point inward.
WHAT IS GOING ON?! MAKE IT STOP HURTING!
With IT Band Syndrome, ITBS, the IT band is rubbing at the hip or rubbing at the knee and creating an inflammation of the tendon and surrounding tissues. IT band pain may be most noticeably after running, or engaging in the offending activity, for a period of time with the trigger spots being at the outside of the knee, hip or the line connecting the two.
Problems:
•Running around a track, the shoulder of the road, or a banked surface
•Tight muscles, as mentioned for the desk worker
•Increasing Distance, Duration, or Intensity of workout too quickly
•Over-pronanting at the food strike in running
•Toes facing frame in cycling
How do I know if I have a problem?
•Do you have pain when you press along the outside of your thigh with moderate pressure while your leg is extended?
•Do you have a noticeable wear pattern on the outside heel of your running shoe?
•Do you feel like you have a weak core or weak back?
•Is the pain worse midway through your run?
•Do you notice a “snapping hip” where it feels like the muscle or tendon is crossing the outside of your hip can be felt while you run?
•Do you have a slow pace or a short stride?
Treatment
Ok, ok, I have a busted IT band. HELP!
Getting evaluated by a licensed and experienced practitioner can make all the difference in the world with ITBS but there are a few things you can try doing at home first.
- STRETCH (we will come back to proper stretching techniques)
- ICE/HEAT (ice for 20 minutes post workout; use heat prior to workout and after icing)
- ANTI-INFLAMMATORIES
- Getting on a good Omega-3 Fish Oil protocol of approximately 3-4g a day will help mitigate inflammation
- NSAID, like Ibuprofen, can help but may have side-effects to consider
- FOAM ROLL
- THERAPY: Acupuncture, Massage, etc.
- SLEEP: this is when your body heals itself. You have to be getting adequate sleep
- SUPPLEMENTAL THERAPY
- Find an acupuncturist, chiropractor, massage therapist, or physical therapist trained and experienced with athletes
- SOAK in a hot bath with Epsom Salts
Evaluation
Some of the things a practitioner will look for in ITBS are muscle imbalances.
•Hip abductor weakness can cause pain because the thigh bone, femur, has a external force acted on when the foot strikes the ground. This will push out on the hip creating more strain on the IT band if the muscles on the inner thigh aren’t strong enough to prevent excessive force on the outside of the hip
Physical Assessment Tests
•Tight hip flexors (iliopsoas), extensors (gluts), and rotators (piriformis) can all put excessive strain on the muscles of the inner thigh, the hip abductors
•Noble Test: positive test when patient has pain at 30 degrees flexion
•Thomas Test: positive test of the iliopsoas and/or IT Band when the patient can’t achieve 90 of knee flexion and neutral angle of hip flexion in relation to the table
Returning to Activity: Don’t Always Run Through It
Pain is the message our body gives us to knock off whatever we are doing. There is a fine line between discomfort, pain, and injury. Sharp pain needs to be taken seriously and evaluated. Once you feel like you have your pain under control be careful when you return to running. Take the following steps to prevent your return your sport from being painful or premature
- Equipment Check. Make sure your shoes aren’t worn and are appropriate for your foot type
- Muscle Check. Incorporate strength training of the inner thigh, buttocks, and core to ensure proper biomechanics in your stride
- Body Check. Make sure your body is well rested, well hydrated, stretched and not inflamed
- Stride. Overthinking your stride can create more harm than benefit but making minor tweaks to your length and speed can make all the difference
- Train smart. Never increase more than one variable at a time in training
- Distance (mileage), Duration (minutes actually exercising), Terrain (pavement vs. trail vs. track), Intensity (hill workouts vs. normal workouts)
Augment your stride to prevent exasperation of symptoms.
“The angle of the knee during faster-paced running is beyond the friction point of ITBFS, so the patient should start with easy sprints on even surfaces, no more than every other day at first. The patient may gradually increase distance and frequency according to tolerance. Time to return to sports depends on the initial severity. Patients who return must first perform all strength exercises and stretches without pain. Running Times also suggests running faster as a method of preventing aggravation to the IT band.
Strength Training and Flexibility
Working to rehab or prevent ITBS is a combination of stretching and strength training.
Strength Train:
•Walking Lunges: it’s important to have good form and go to muscle fatigue, not muscle pain. If you’re feeling pain adjust the depth and length of your lunge
•Resistance Band Leg Raises: Lay on your side with your knees bent at a 45 degree angle. Have a snug resistant band around both legs and lift the leg you’re not laying on towards the ceiling. Do approximately 15 reps on each side with 2-3 sets (note that in the video the legs are straight, this an acceptable adjustment)
•Side Steps Resistance Bands: fix the resistant band around your ankles and step sideways, 15 reps on each side with 2-3 sets
•Squat Leg Raise: Stand on the resistant band and go into a squat (remember to not let your knees go over your toes). When you come up from the squat, with alternating legs, bring one leg out to the side. Alternate and do 15 reps on each side with 2-3 sets
Stretch:
Stretching needs to become part of your life, not just before and after runs. If you’re like the majority of the population you are sitting for the majority of your day. Set and alarm to get up EVERY 30 MINUTES and stretch your hips.
Here is a video of good IT Band Stretches
When all else fails, rest. Overtraining an area is not going to make you reach your goals quicker. If a certain run-time or distance is a goal, work on other aspects of your fitness to help you get there while you recuperate your injury. Constantly reevaluate and reassess your training, fitness, and goals. Working with a trained therapist can provide an unbiased and honest opinion of your injury and recovery while facilitating the healing process.
