Do you struggle with running at the same level you used to be able to do a couple of years ago? Do you have knee pain when you hit the pavement for your run? In this article we’re going to cover the 5 things you need to know about Iliotibial Band Syndrome!
If you are more of the visual and auditory learner just click the YouTube video below outlining everything that is in this article!
What is IT Band Syndrome?
This is the most common overuse injury in runners. The iliotibial band is actually connective tissue that connects to a muscle in your hip. This muscle is the Tensor Fascia Latae or simply referred to as the TFL. This is a small muscle on the outside front part of your hip. This connects to the iliotibial band which runs down the outside of your thigh and connects into the bone that crosses the knee joint. Where you really run into problems is where the ITB crosses the knee, that’s where we see most of the pain in our patients. So, the IT band is connective tissue, not an actual muscle, which is why it’s called a band. It’s fibrous connective tissue like the fascia in the body. The reason why it’s going to be really tough to stretch this structure is because it’s a tough connective tissue and the majority of it is this long band and then the small little muscle in the hip. Technically you can stretch the muscle in the hip, but the band itself you cannot.
Iliotibial band syndrome is more common in females. The rationale and reasoning behind this is because women have a larger pelvis! The wider pelvis puts women as a disadvantage when it comes to running!
How do I know if I have it?
There will be very localized pain to the outside part of the knee. The pain will be very specifically pinpointed to the outside part of the knee. Sometimes this pain can be confused with a meniscal tear. A meniscal tear is completely different from ITB syndrome. A meniscal tear occurs from a specific event or trauma and is normally associated with clicking or a catching feeling in the knee. Iliotibial Band Syndrome occurs overtime with what we call an insidious onset. Maybe one day you’re running and feel a little bit of pain and then the next run it’s worse and then it’s highly irritable and you can’t ignore it. That’s when we would start consider Iliotibial band syndrome.
A common question people have is do I need imaging such as an X-Ray or MRI to determine if I have ITB Syndrome? The answer is no! The history and onset is normally a clear give away and then a good physical exam by your running physical therapist will help to differentially diagnose and determine if you pain is in fact Iliotibial band syndrome. An x-ray will not show anything regarding this diagnosis as x-rays show bone imaging. An MRI would show the iliotibial band but it won’t show any damage to the tissue itself. Based on this, you want to see your physical therapist first instead of needing to go to an orthopedic physician who is a surgeon. In case you were not aware, you do not need a prescription first to go see your Physical Therapist, you can go directly to your PT for a diagnosis!
What causes it?
ITB syndrome is mainly a repetitive overuse injury. As your knee is bending back and forth during running you’re causing irritation to the tissue. Another sport that is common for this syndrome to occur is in cyclists and triathletes who are cycling and running performing many repetitions of repetitive knee bending. Another aspect that can cause this condition is if your leg rotates in. If you’re flat footed and you overpronate during running, your leg will rotate in and can cause more stress on the outside part of the knee. Something else we want to pay attention to is the surfaces that we’re running on. First of all, look at your sneakers. If you’re getting a lot of wear and tear on the outside of your sneakers, that may be a good indication that your foot is pronating and rolling in too much. If you’re running on a lot of country road and the road that you’re running on is banked, you’re always going to have one side that is higher than the other, and you’re leg is going to be rotating inwards. This can be a contributing factor and cause as to why you’re getting ITB syndrome. Another factor can be if you’re running on a track going only one way, you’ll get that same situation where one side is higher than the other! These are all contributing factors that may lead to Iliotibial band syndrome.
How do I get better?
So how do we treat Iliotibial band syndrome? First and foremost, you’re going to need to back off your mileage. We’re not saying shut down running. However, if you’re having current pain, you need to back off a little bit so that you can allow some healing to start. You need to think about switching up the surfaces! If you’re running on those banked surfaces, you need to think about running on some flat surfaces. If you’re doing a lot of mileage on a track, think about some safe roads that you can run on or switch it up on the track and run the other direction. It may look silly but it’s healthier for YOU! If shoe wear is the contributing factor, you should be counting your mileage. You should be switching your shoe wear every 300 to 400 miles. Track your miles so that you’re aware of how much you’re putting on your sneakers. Only wear your running sneakers for running so that you can track how much damage those shoes are taking primarily from running.
Next, you’ll want to foam roll your iliotibial band. However, Do NOT roll on the outside part of your knee where you have all of your pain. You won’t feel any better and you’ll just cause the pain to increase. You’ll want to roll the Tensor Fascia Latae muscle in the hip and then roll in front of the IT band and slightly behind the IT band. This will cause a decompressive effect to the actual band! Do not roll right on the side and go for the kill, it’s extremely painful and you won’t feel any better! Click this LINK to see my personal recipe on how to foam roll the TFL and ITB.
You’ll need to strengthen the glute muscles. Primarily, you’ll want to focus on the gluteus medius muscle which is your outside hip muscle. This muscle stabilizes your pelvis when you are running and you step on the leg. Every time you step on your leg, every time you’re running you are only stepping on one leg and the gluteus medius helps to stabilize here. We want strengthen this muscle primarily to prevent the leg from dropping in as that can be a contributing factor to the development of ITB Syndrome. This is by far one of the most important muscles runners need to focus on strengthening! Click this LINK to see my favorite gluteus medius isolation exercise for runners to wake this muslce up!
How do I prevent it?
This is actually the fifth tip in our five tips of healthy running! You have to train smart with proper progression! We don’t want to go out there and ramp up our mileage out of nowhere. You need to be smart about your training. You always want to think about your shoe miles. Take a look at your shoes BEFORE you get your pain. Are you tracking 500 miles? Go replace your shoes! That way you can prevent the condition before it happens. Next, we want to think about strengthening! Strengthening your hip muscles, quad muscles, your core muscles! Running is a repetitive activity and you want to be strong in all areas. You want to train smart so that as you progress as a runner, you will be able to run to your best ability!
Check out all 5 of my healthy running tips in this previously posted blog article by clicking THIS LINK
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Thank you for taking the time to read,
– Duane Scotti, PT, DPT, PhD, OCS
A special thanks goes out to Allie Eldridge, SPT for her contributions to this article
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“I struggled to get back into running after being diagnosed with Osteoarthritis in my left knee. A friend of mine suggested I check out the Healthy Runner podcast and I’m glad I did! I was lucky to grab a spot in the Healthy Runner Coaching Program and I have gained so much from miles away. I’ve gained tools to be a lifelong runner through the run and strength plan. I’m constantly gaining more mobility and look forward to my future of running. Duane is a great coach that gives you personalized assistance and helps you understand any questions you have! I’m definitely getting my spark back!”
Working with Duane has been a game-changer for my running. I’ve been in an endless cycle of injuries for the past five years and needed to make a change.
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The best part is Duane is a physical therapist, runner, and coach, so he understands how important running is for our physical, mental, and emotional well-being! If you want to become a stronger, healthier, and faster runner, look no further!
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