IT Band Syndrome

You’re outside. It’s a beautiful spring day. You’re feeling great, but about ½ mile into your run the outside of your knee, out of nowhere, starts to hurt. By hurt, I mean: stops-you-dead-in-your-tracks. You’re probably training for a race – and a thousand thoughts instantly run through your head, from the immediate, “How the heck am I going to get home?” to the more long term, “Can I even continue to train for this race?”

Quite possibly, you have just been bit by ITBS (Iliotibial Band Syndrome). But there is hope! Although it’s not completely innocuous, ITBS is actually a very common injury and one that is easily treatable through rest, stretching and strength exercises.

The iliotibial band is a thick structure of white tissue, known as fascia, which stretches from a the outer portion of the hip to the lateral portion of the patella (kneecap) as well as the lateral portion of the tibia (shin bone). Its function is to enhance lateral stability of the hip and knee as well as assist in certain hip motions.  Any runner who has experienced ITBS can tell you that when it hurts, it REALLY hurts.  Fortunately, when you have distal IT Band pain, it’s quite recognizable, as the scenario above.  Other injuries, such as kneecap pain, or patellofemoral pain, have IT Band tightness as a major contributing factor.

How do I treat it?

Most orthopedists recommend (in a case of acute inflammation) shutting down your running activity for 2-4 weeks, then gradually building back up (starting as low as ¼ of a mile and then moving on.)  Anti-inflammatory medications, under the direction of a physician, can also be helpful. Stretching the hip flexor muscles, as well as strengthening the hip girdle, is also extremely helpful.

Sometimes, using a foam roller as a type of soft tissue massage can be very helpful with ITBS symptoms. Warning: the foam roller is not for the faint of heart – I have had patients who would have told me their family secrets if I would have allowed them to stop this exercise. But you’re a runner, right? You can take it!

A referral to an orthopedic physical therapist who is familiar with running and runners is never a bad idea, as you can always benefit from a treatment regimen specifically tailored to you. On that note, when you go to see an orthopedic physician, if you get that far, attempt to seek one out who knows runners. There are physicians, usually runners themselves, who truly understand your needs both physically and more importantly, emotionally; and these providers are uniquely equipped to handle your injury.

The iliotibial band can be a troublesome structure, but laying the foundation of a strong core/hip complex, as well as a good stretching routine will go a long way toward stopping your IT Band syndrome from ruining your running goals. Here are some easy exercises to get you started: (Click images for a larger view.)

Lateral Step Up
Stand next to a chair, aerobic step or other sturdy platform that will easily hold your weight. Step sideways up onto the platform and extend your leg before gently lowering yourself back to the ground. You can make this exercise a little more interesting by stepping up onto the platform and then lowering yourself down the other side to alternate legs.

Lateral step-up

Side Lying Hip Abduction
Lie on your side with your legs extended straight away from your body. Gently raise the upper leg off the lower leg while keeping the knee extended and the foot in a neutral position (pointing straight forward). Continue raising the leg as far as it will go without your lower hip raising off the ground. Slowly return the raised leg to the starting position.

Side Lying Hip Abduction

Kneeling Hip Flexor Stretch
From a kneeling position, place the right knee on the floor directly under the right hip, and place the left foot in front of the left hip so that the left knee is directly over the left ankle. Maintain a straight, tall posture. Lean forward into your left hip while keeping your right knee pressed into the ground. Do not allow your pelvis to tilt forward. To increase the stretch to the right hip flexors, squeeze and contract the glute muscles of your right hip. Repeat with the left knee on the floor.

Kneeling Hip Flexor Stretch