My apologies for the delay between articles. The creative process is a delicate one…or so I’ve heard. No matter, here is my latest debut. Late, but always worth the wait!
Without a doubt, iliotibial band syndrome – better known as ITB syndrome – is one of the most unpredictable yet debilitating injuries a runner can sustain. ITBS (not to be confused with IBS) can strike anytime, anyplace, and without warning or mercy (although the same would also be true of IBS I suppose…). It is the proverbial ninja of the injury world. The real kicker (pun intended, thought I’d capitalize on some aftershocks still reverberating from the clever ninja analogy) is that the pain onset associated with IT band syndrome is often haphazard. This means your first encounter could be anywhere on the severity spectrum, from a minor twinge to un-runnable agony.
This injury typically afflicts more seasoned runners, and sometimes beginners, who put in more mileage – upwards of 30 to 40 miles a week or more. Just like other ailments, ITB is an overuse injury that results when your body isn’t quite ready for the amount of work you’re demanding from it.
What’s The Happs?
So what’s happening when your IT band goes on the fritz? The IT band is a thick band of fascia (like tendons or ligaments) that originates at the hip connecting the glute muscles, then runs laterally down the thigh past the knee to insert at the top of the Tibia (shin bone). As the ITB extends down over the outside of the knee it becomes thinner. If the mood strikes it just right, this portion of the band will rub over the femoral epicondyle (fancy terminology describing some boney protrusions at the end of your thigh bone that meets at the knee). This causes the fascia to become inflamed and subsequently results an intense, sharp pain at the knee that can quickly turn your typical 5-mile run into a shameful 5-mile hobble home. Often runners will assume they are having knee troubles, which is not the case at all.
Some of the blame can be placed on genetics or poor lower body strength, as the angle of your hips and knees can predispose that narrow end of the fascia to rub regardless of mileage. If your knees naturally tend to turn inward (more characteristic of women) there is additional stress on the ITB. Strengthening your Gluteus Maximus (your bum muscles) can help with some alignment issues if your problem stems from the hip.
ITBS can be generalized pain and discomfort anywhere throughout the outside of the thigh, but predominately manifests at the knee. For me, ITBS would send a sharp pain to the outside of my knee that would not accept any amount of weight bearing while running, and only enough for a pathetic hobble whilst walking. However, everyone is different. Some experienced an intense, throbbing ache that was continuous and included swelling at the knee. Generally speaking, pain at the outside of the knee and thigh is probably a result of a tight IT band. An MRI will usually reveal ITBS, but is generally not necessary given the discerning nature of the injury.
As we look at treatment options, it is important to remember that very critical fact that we learned about connective tissue such as ligaments or fascia… It is not a vascular tissue so that means little blood flow and slow healing time.
Treat The Beast:
The nice thing about this injury versus some of the others we’ve discussed is that with some aggressive treatment, you can see relief relatively quickly (sometimes instantly) despite the natural tendency of connective tissue to take its sweet time in healing. However, if neglected this injury can become chronic which may mean a more permanent decrease in running distance and intensity.
R.I.C.E. – Rest. Ice. Compression. Elevation.
I’m going to attempt to put a positive spin on this so bear with me. With some injuries, like plantar fasciitis or other forms of tendonitis, you are able to push through the pain which of course makes it worse and results in extended layoffs and months of TLC (this article is full of acronyms). This is a bad thing, we should not push through injuries, obviously, because they won’t get better. The great thing about ITBS? Chances are it’ll hurt so bad that you literally won’t be able to run on it! Consider this forced hiatus a blessing, it is your body taking a stand by telling you to have a seat. A couple days, maybe a week or two, will give you some much needed recovery. During this time when the injury is most tender, be sure to ICE, ICE BABY! I will continue to drill this simple, yet crucial, step toward recovery.
Want to take your icing to the next level? But a pack of paper Dixie cups (or something similar, it just has to be paper), fill a cup ¾ of the way with water, and stick it in the freezer. After it’s completely frozen, take it out and tear away portions of the cup to expose the ice. Then take the ice to your inflamed IT band and roll it around the injured area. This creates an ice massage, two treatment therapies that make magic when paired together.
No, I’m not referring to the song by Ludacris… I’m talking about the infamous foam roller. This is the treatment you are going to love to hate, but it is probably the single most effective action you can take against your ninja fascia. The foam roller comes in all shapes, sizes, colors and designs but all are intended for the same goal – stretch out the ITB. This is the single greatest investment (aside from shoes of course) that you absolutely must make as a runner. My dear friend and former SRC employee Keryn, who recently left for England to pursue her Master’s Degree, can attest to this fact. We took her to the airport, everything she owns crammed into two large bags and a backpack…including her beloved “Y” roller. She attempted to check said large bags, but regrettably exceeded the generous 50lbs allowed by airport standards. The “Y” roller – along with a deflated stability ball, about four pairs of shoes, and some large sweaters – had to be sacrificed as per my recommendation.
First message I get from my dear friend upon her arrival in the UK? “I hate you, I need my Y roller cuz my IT band is about to blow up.” I miss you too…
Moral of the story? Get a foam roller because you will always wonder how you lived without it.
The roller allows you to use your body weight to massage and stretch critical areas to relief tightness, most notably for your IT band. Proper rolling technique can be found on a set of instructions included with your roller, and countess demonstrations can be found on YouTube.
Note: Foam rolling hurts like crazy, it’s a pain unlike any other. Pain is usually bad, but in this case if you’re crying…you’re probably doing it right. This leads me to the next treatment…
Stretching is so important in order to maintain healthy muscles, joints, ligaments and tendons. Just because your pain is manifesting in the IT or knee, doesn’t mean that area is the culprit. In fact, often imbalances on one area of the body will cause problems in another (seemingly unrelated) area. As mentioned before, your IT band could be irritated because your Glute muscles are too tight or too weak. Often the stretches we don’t like to do are the ones we need to do the most. For ITBS, make sure to stretch out your glutes, hamstrings, quadreceps, hip-flexors and adductors (the most medial, or inner, muscles of the leg). More traditional stretching exercises can be done, or you can use your newly acquired foam roller or even a Trigger Point Massage Ball to get deep into those needy tissues.
For those who constantly suffer from IT band pain, it might be worth considering a compression strap. The band wraps tightly around the lower end of the thigh, right above the knee, and is designed to apply pressure to the IT band which prevents the excessive movement that causes irritation. The strap is relatively comfortable, just make sure to get the correct size.
The Last Resort
ITBS that refuses to quit may require a more invasive treatment. Cortisone shots are an option, but again if the injection is not made in the correct spot it could all be for not. Additionally, tendons and ligaments are weakened by cortisone. Not intended to strike fear into your heart, but personal experience has taught me that this little factoid about cortisone is a rude awakening for those with first-hand experience. I am still a believer in cortisone shots despite having suffered from a ruptured fascia due to injection-induced weakness, but it is best to leave it as a last resort.
And finally, there is always a surgical route where the fascia tension is released. I am sure one of the above options will bring you relief so I am not going to delve into the surgical option any further.
I hope you remain positive through all your trials and tribulations. It is in times of struggle that our true character is forged. Be diligent with your recovery and go forth in your running endeavors!
P.S. As a side note, I have another matter I’d like to put on the table for all our running readers out there. Is there a topic of interest that you’d like to read about? Feel free to email me suggestions. Additionally, I would like to add some motivational and informational pieces to the blog as well. Feel free to send me your photos and personal stories about running triumphs, amazing places that you have run, and events that you love and it might just make it on our page! Email us at firstname.lastname@example.org.
“Inside the Doctor’s Office: IT Band Syndrome.” Runner’s World. 2012.