Iliotibial Band Syndrome

ITBS

Iliotibial band syndrome (ITBS) is a common injury among runners and is characterized by pain or aching at the lateral side of the knee, which generally occurs partway into a run. As the condition worsens, the pain gets more intense and onset occurs closer to the beginning of the workout.

What are the main factors of ITBS?

Anything that repetitively causes the leg to bend inward (relative to the knee) and / or puts strain on the iliotibial band is often the cause of ITBS. One or more of the following are often the main culprits: muscle imbalance (weak hip abductors), sudden increase in running mileage, excessive downhill running, extensive training on uneven ground, track running (always in same direction), bow-leggedness, over-pronation, improper footwear and discrepancies in leg length.

So, exactly what and where is this ITB?

The ITB is a thickened portion of the fascia (a sheath of connective tissue surrounding the lateral leg muscles) that runs along the lateral upper leg. The ITB begins at the tensor fascia lata muscle, which is a hip abductor, and inserts on the upper lateral surface of the tibia (the bone at outer side of the knee).

What actually causes the pain?

Hip abductor muscle weakness, most commonly in the gluteus medius, is one of the main causes of ITBS. Although the pain is felt at the knee, the root of the problem is actually located closer to the hip. As I previously stated, the tensor fascia lata inserts into the ITB and is responsible for hip abduction. When other hip abductors such as the gluteus medius are weak, the tensor fascia latae must compensate. The end result is an overworked tensor fascia lata and a stressed and tight ITB. The tight ITB will rub on the femur (actually on the femoral area on lateral side of knee) and cause friction. The friction leads to inflammation in the area and pain.

I think I have ITBS. How can I treat it?

1. Decrease your running mileage or stop running completely for a while.
2. Avoid running on uneven surfaces, reduce downhill running and avoid stairs.
3. Apply ice to the sore area (10 minutes on, 10 minutes off).
4. Massage. Seeing a masseuse or applying a self-massage works well. For self-massage, roll a rolling pin along the outside of your thigh (muscle and ITB). Do not massage the sore area beside the knee, because that will only cause more irritation.
5. Stretching. If you are trying to stretch the left side, stand with right shoulder facing wall and cross your right foot in front of your left. Stabilize yourself by putting your right hand against the wall. Keeping your left foot planted and your left leg straight, push your left hip away from wall and allow your right leg to bend. You should feel the stretch along your outer left thigh. Hold the stretch for 30 seconds and repeat.
6. Take an NSAID (non-steroidal anti-inflammatory medication), such as ibuprofen.
7. Reassess your running shoes.

Cross-training options

I mentioned above that in order to get rid of ITBS you might have to stop running for a couple of weeks. Being a runner myself, I know that is hard to do, especially for you diehard runners. Here are some cross-training ideas to hold you over until you can resume running: pool-running, swimming and cycling (low resistance).

How can I prevent developing ITBS?

1. Stretch quadriceps, hamstrings and gluteals regularly.
2. Do some strength work to prevent any muscle imbalances, especially with hip abductors.
3. Increase running mileage gradually.
4. Be sure to take adequate rests between workouts.
5. Make sure you are using proper footwear. For example, over-pronators need motion-control shoes and / or orthotic shoe inserts.
6. Avoid excessive downhill running.

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