Running with IT Band Syndrome
The iliotibial band is a thick piece of connective tissue that runs parallel to your femur (thigh bone) from the outside of your hip to just below your knee. Pain is characteristically felt at the end of the IT band where it attaches to the outside edge of the knee. Iliotibial band syndrome (ITBS) has been compared to the feeling of somebody stabbing you in the side of the knee when you run, especially when going downhill. This annoying and painful injury can quickly become crippling if not addressed and corrected.
The symptoms of IT Band Pain
- Pain is most frequently felt as a sharp point on the outside of the knee, or (rarely) as sharp pain on the lateral side of the hip.
- Commonly, pain occurs after a certain amount of running; not in the first few steps.
- While pain generally goes away after stopping activity, it often comes back when running is resumed.
- It’s most common in new runners, or after an increase in mileage or hill running.
The cause of IT Band pain
Most people mistakenly believe that ITBS occurs because of a tight IT band — but the IT band is intended to be tight to do its job. The source of the problem is almost always weak hip and gluteus muscles. Weak gluteus muscles result in excessive side-shifting or movement of the pelvis which causes your femur (thigh bone) to move abnormally; the outcome being unusual loading of the supportive IT band, ‘pulling’ it away from your knee.
Running downhill and always running on the same side of the road close to the pavement are common culprits. This is due to the camber of the road tilting your pelvis resulting in one leg remaining ‘longer’ than the other. This also applies to track and field running in which your inside leg takes shorter strides than your outside leg. Consequences of running at angles can put a lot of stress on the side of the knee causing friction between the IT band and the femur. Over-pronation and a leg-length discrepancy can also be contributing factors.
Many runners find that as fatigue sets in, their ankles or knees collapse inwards, which in turn pulls on the IT band forcing it to rub against that bony spot on your knee. This re-enforces the importance of having strong legs to prevent injury. This can be achieved through specific strengthening exercises.
Treatment of IT Band pain
ITBS can be challenging to treat, but gluteus muscle and hip strengthening are immensely important in both the prevention and treatment processes. A regimen of icing and anti- inflammatories will assist in reducing pain. A foam roller can be used to loosen up tight structures as well as massage. Physiotherapy treatments will work on releasing structures that are shortened and tight – movement-based treatment for soft- tissue injuries will help to break up scar tissue and restore normal function.
Strengthening exercises for hip abductors, core and gluteus muscles will be important along with a stretching programme. Adjustments to training programming including avoiding aggressive downhill running, reducing volume and intensity of training
Recovery and prevention
IT band syndrome can take 4 weeks to 8 weeks on average to fully heal; this includes treatment and adjustments. Rest is important and will help prevent pain from returning or worsening to a chronic condition. Most running patients we treat have been able to run during recovery continuing their normal training program after making adjustments to training. Cross training with non impact loading activities such as swimming can be helpful.
Maintaining good soft tissue mobility is essential. Regular stretching and massage as well as foam rolling can help prevent the development of ITBS. Strengthening the gluteus muscles and hip, including your core will provide a more stable pelvis and reduce the ‘tugging’ on your ITB. A little proactive rehab goes a long way to preventing most running injuries and is less costly and time-consuming to practice healthy than when injured.
Always look at your training programme and monitor volume and intensity, as well as excessive downhill routes., too much too soon will cause ITBS. Remember tips like running on different sides of the road and switching directions if running the same routes frequently or round a track. Have your form assessed for excessive pronation and get advice about orthotics, as they may help prevent an injury. Vary running surfaces as well. Mix hilly runs with flat routes. Try trails and soft surfaces to ease the pounding placed on legs by only running on roads.
The information contained in this article is intended as general guidance and information only and should not be relied upon as a basis for planning individual medical advice. If you are suffering with Shoulder impingment, contact us today for free advice and support.