3 phases to beating IT band syndrome

Iliotibial band syndrome, or ITBS, is one of the main causes of knee pain in runners. The IT band, or ITB, can become so painful that a runner is unable to train at all. ‘You need to address both the cause and the symptoms,’ says Mark Fadil, director of Sports Medicine Institute International (SMI) in California, US.

The ITB is a fibrous structure that assists the stability of the leg during the stance phase of the stride, works with the hip muscles in abduction (outward movement) of the thigh and helps to resist torsional movements around the knee joint. It begins in the hip as the tensor fasciae latae muscle and ends below the knee joint, inserting into the tibia at a bump called Gerdy’s tubercle.

When the ITB becomes stressed through overuse, runners usually feel pain in the outside of the knee, above where the ITB crosses the joint. This is sometimes accompanied by a clicking sensation, caused by the ITB snapping across the joint. The pain usually occurs just after heel contact and gets worse as the run goes on. Downhill and long, slow running tend to worsen the symptoms.

While the ITB will become tighter when it is injured or overstressed, this tightness is not the root of the problem. The ITB is not strong; any weakness in surrounding muscles can lead to injury, and runners are often weak in their hip and core muscles. In 2000, Dr Michael Fredericson, from Stanford University, US discovered that weakness of the hip abductor muscles (mainly the gluteus minimus and gluteus medius) was the leading cause of ITBS. In 2007, research in the journal Clinical Biomechanics found female runners who develop ITBS have an increased hip abduction motion, along with greater knee internal rotation – both probably caused by weakness in the hip abductors.

How to beat ITBS

Treatment 1: Reduce pain and inflammation

The initial phase focuses on reducing pain and inflammation and increasing mobilisation of the ITB. Rest, ice, non-steroidal anti-inflammatory drugs (NSAIDs) and topical anti-inflammatories are all effective in this initial phase. A corticosteroid injection can help – with the understanding that it is not curing the injury – to reduce the pain and enable the runner to move on to the next phase.

Treatment 2: Massage and stretch

Treatment progresses to deep-tissue massage, before moving on to strengthening. Fadil recommends frequent massage: two or three times per week for recreational runners. If you cannot afford to go to a certified massage therapist, a foam roller can work well for self-massage, or a tool such as the ROLL Recovery R8 or The Stick. Roll from knee to hip. Maintain fitness with cross-training that does not aggravate the condition. After the pain subsides, add stretching (see below) while continuing massage.

Treatment 3: Strengthen

Begin strengthening as soon as the exercises (below) can be performed painlessly. As you get stronger and symptoms subside, test the injured leg with short runs that can be extended once the pain is not causing a limp or compensation. Strides can sometimes be performed early in this phase – shorter, faster running often does not worsen the injury. Recovery time depends on factors such as the length of time you have been injured and biomechanical aspects of your stride. Continue strengthening after you have resumed training.


Stretch

Lengthening stretch

The best ITB lengthening exercise is to stretch it across the hip and outside the leg. Cross the injured leg behind the other leg and lean toward the uninjured side. First stretch with your arms over your head, creating a bow shape from ankle to hand with the injured ITB outside, then bring your arms down to touch the ankle on the inside of the bow.

The runner’s right leg is being stretched here. Hold the pose for 15 seconds and repeat 10 times. Perform three sets a day.


Strengthen

A/ Clamshell

Begin with a clamshell exercise using a resistance band. Lie on your left side, with your knees bent and hips vertical. Activate your side abs and squeeze your glutes. Keep your feet together and slowly raise your right knee. Hold for five seconds, then lower your knee back to the starting position. That’s one rep. Perform the exercise slowly, with emphasis on good form. Build up to three sets of 10 repetitions on each leg.

B/ Side leg lifts

Lying on your side, raise your top leg straight up to around a 45-degree angle, toe pointed down. Then slowly pull the leg back in that plane, move it forward and return it to the starting position. Form is very important – in the starting position, check your body is in a straight line from shoulder to ankle, with the top hip slightly in front. (Don’t let the top hip rotate backward.) Build up to three sets of 10 repetitions on each leg.

C/ Single-leg squats

Balance on one foot, then bend your supporting knee to lower your torso a quarter of the way to the ground. Ensure the knee stays directly over the foot. Once you master this squat, add the challenge of mimicking running form: extend the unsupported leg behind you and bring it through to lift the knee in front of you. Progress to touching the ground in front of your body on the forward lean. While standing on your right foot, move a ball up and down diagonally from lower left to upper right, then side to side in a twisting motion. Repeat on the left foot, moving the ball from lower right to upper left.

D/ Hip hikes

Eccentric strengthening works the hip abductors in the same manner they function during running. Standing on one foot on a step, raise the other foot by lifting your hip on that side, while taking care to stay in an upright position. Slowly lower the hip to the bottom of your range of motion, while staying upright. Perform 10 reps on each leg; build up to three sets.


Photography by Mitch Mandel