One of the most common overuse injuries sustained by runners is Illiotibial Band Syndrome (ITBS). The most common early symptom is a sharp, burning pain on the lateral (outside) part of the knee while running. In my experience working with marathon training programs, I’ve noticed that ITBS is a common injury with individuals preparing to run their first marathon or half-marathon. ITBS is an overuse injury and the causes are both biomechanical and related to training mistakes.
What is the Illiotibial Band?
The “IT Band” is not a muscle. It’s a long piece of connective tissue that runs from the gluteus/hip area down the lateral side of the leg to the lower attachment area at the knee cap and top of the tibia shin bone. The IT Band is not very elastic – it has the tensile strength of soft steel which makes it difficult to stretch.
What causes ITBS?
There’s not one specific cause of ITBS. Like many overuse injuries, ITBS is usually the result of several factors. Some of the biomechanical factors include:
- Tightness of the IT Band. Some individuals have tighter IT bands than others.
- Myofascial restrictions in the hip and thigh muscles. All muscles are encapsulated with thin myofascial layer. If that layer is overly restrictive, it can contribute to the onset of ITBS.
- Weakness in the hip abductor muscles (common in runners). Explained simply, most of the hip abductor muscles make up the gluteus (butt!) muscles.
- Weakness or poor control of knee muscles, especially the quadriceps muscles.
- Dominance of the anterior (front) hip muscles over the posterior (rear) hip muscles
- Excessively flat feet or very high arches
- Bow legs or “knock-knees”
- Leg length discrepancy
- Limited ankle range of motion
There are also training mistakes that can contribute to ITBS:
- Sudden and significant increase in weekly training mileage
- Over-striding
- Worn out running shoes
- Failing to warm-up and cool-down adequately
An Ounce of Prevention is Worth a Pound of Cure!
If you’re training for your first marathon or half-marathon, there’s a good chance you’re running more mileage than you’ve ever run before. Because we train on mostly flat terrain here in southeast Louisiana, we’re at a bit higher risk for ITBS. Our gluteus muscles don’t get much work due to the lack of hill training. There are a few proactive steps you can take to prevent the onset of ITBS:
- Make sure you always have quality running shoes in good condition. For most us the average life-span for a pair of running shoes ranges from 300-500 miles. I highly recommend alternating between two pairs of running shoes when you’re in the midst of higher mileage training
- Gradually increase your training mileage. One of the tried-and-true rules of distance training is to limit your mileage increase to no more than 10% every one or two weeks.
- Try to run on flat even surfaces and avoid running on crowned roads
- Warm-up and cool-down. I always start off nice and slow and then throttle back on the pace when I’m a half-mile from finishing
Okay Coach, I already have a bad case of ITBS…what can I do?!
If you’re in what is called the “acute phase” of ITBS it’s always a good idea to modify your activity. If it hurts while you’re running, I recommend hitting the pool for a week, swimming with a pool buoy between your legs to reduce the strain on the IT Band while you’re in the water.
Stationary bikes and the elliptical machine are two other options. Although your knee is bending, it’s bending at a different angle and the biomechanics are a bit different from running. As always, if your IT Band hurts while you’re on the bike or elliptical, head back to the pool or discontinue any training until the pain subsides.
Like any inflammation injury, ice is always the recommended post-workout treatment. An ibuprofen product like Advil or Motrin might also help – ibuprofen seems to be a bit more effective than acetaminophen (Tylenol) for inflammations.
If the ITBS pain is severe, it’s important that you take a break from running. It’s okay to take some time off and it usually takes about 10 days of inactivity before you start losing your conditioning base.
Once the pain starts to lessen and you move into the “sub-acute” phase of the injury, there are a couple of additional things you can do to speed along the recovery process:
- Purchase a foam roller and apply direct pressure by rolling back and forth on your hip.
- It’s time to start incorporating IT band stretches and gluteus muscle strengthening exercises into your daily fitness regimen
In next week’s CYJ installment, we’ll review some stretches and strengthening exercises that help keep ITBS under control.
Fred Klinge works for Varsity Sports and is currently certified by the American College of Sports Medicine as a Health/Fitness Specialist. Fred has completed 29 marathons, with a personal best time of 2:18.15. He can reached at fred@varsityrunning.com.
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