Managing and Preventing Iliotibial Band Syndrome (ITBS)

Running injuries are the plague of many runners. The sad truth for the sport of running is that it is classified as a high risk sport when it comes to injuries. The reality is that this is totally unnecessary — developing fitness, coordination, and technique together and correctly are very good at preventing major issues for most people. The five most common running injuries are runner's knee (patellofemoral pain syndrome), iliotibial band syndrome, plantar fasciitis, tibial bone strains, and Achilles tendinosis.

Today we shall focus on the second most common running injury: iliotibial band syndrome. The symptoms usually show up as pain on the outside of the knee and sometimes in the hip. It can include swelling near the knee and pain or tightness anywhere along the IT band. Much like PFPS (runner's knee), the issue isn't a knee injury- its something stressing the knee from elsewhere. Injuries to the knee itself are actually pretty rare for runners.

So, definitions: The iliotibial band (IT band) is a band of tendinous tissue runs along the outside of our upper legs from the outside hip flexors, to just past the knee ending at the top of the shin bone. The name gives it away: it goes from the iliac crest ('ilio' in iliotibial) to the top of the tibia (the larger of two bones in the lower leg). The IT band exists to prevent the pelvis from tipping to the side when one foot is on the ground.

What ITBS might be about

There are two main theories about what is happening in ITBS. One says the bottom of the IT band rubbing repeatedly against the bottom of the femur stresses it until there is inflammation, tissue breakdown, and a thickening of the band in that area. The other theory says the IT band doesn't actually move in that way- its really a layer of fatty tissue and looser connective tissue getting compressed between the IT Band and lower femur. Take your pick of those theories, but fortunately the causes and solutions are more clear.

Causes

The IT band can get injured for a variety of reasons. Anything that causes the knee to turn inward repeatedly can be an issue:

• running on banked surfaces
• like the sides of many roads,
• running downhill,
• weak hip stabilizers
• worn out shoes,
• too many track workouts in the same direction,
• or simply too much running.

Surprisingly, fast running is rarely the issue. In fact, some relaxed sprints during a run can even help with ITBS recovery in order to lose a little fitness as possible.

Preventing and Rehabbing ITBS

Weak hip stabilizers are an issue because it can cause the knee to turn inward and can result in ITBS. As such, the same exercises that help PFPS will help with ITBS. Check out my article on PFPS for those exercises. There are also specific strength and coordination exercises that help ITBS syndrome. These are exercises such as side laying clams, hip hikes, hip thrusts, and pistol squats.

Tight IT bands are usually a crucial component of ITBS as well. While a sports massage therapist might be the ultimate solution, the more realistic one is to get and use a foam roller. Lying on your side with your arms as support, you can lay on a foam roller to slowly roll up and down the IT band. Use as much pressure as you can handle while still being very careful to distinguish between good and bad pain (bad pain can sometimes be as simple as just too much pain). Pause at points along your hip flexors and IT band where you feel particularly tight or tender, and relax into that spot for at least a couple deep breaths.

So never fear, ITBS doesn't have to be the end of your running! Just be sure to keep your IT band from getting too tight, keep your hips strong, and train smart.