Managing ITBS – (Iliotibial Band Syndrome)

Iliotibial-Band-Syndrome-1Iliotibial Band Syndrome (ITBS) –  pain on the outside of your knee –  is a fairly common running injury.  ITBS sucks.  It’s been very debilitating for me, although after about a month of biking and very little running I haven’t encountered any more issues.  (fingers crossed) I made the cardinal mistake of feeling pain, and continued to run on it. For about three weeks.  I took one week off initially when it got bad, but I was still feeling pain at the end of my runs and I just hoped it would get better.  Against all rationality.  So finally it got to the point when I couldn’t run more than ten minutes without it flaring up.  My knee was sore and inflamed when I  touched it.  I took ibuprofen three times a day to reduce the swelling for nearly two weeks.  Then all of a sudden, with adequate time off, vigilant stretching and hip exercises, I can run again! From the time of first experiencing pain to when I could run again was about two months.  From seriously starting my rehab to being able to run was about three weeks.   What I understand about ITBS is that there are many causes, and it is also not completely understood what does cause it! There does seem to be consensus and science on some things though.

Improper Running Form: I had my gait analyzed, even after I had been focusing on my form for the last few months – eg. increasing cadence, having my foot falls directly under my body rather than out in front, striking forefoot and midfoot rather than heel, and leaning forward.   There is still a lot of work to do.  “The emphasis on foot strike missed the mark by putting the attention on the end of the chain, rather than the beginning. We need to shift our focus upward to our hips and glutes, where the stride begins.”  (First article linked below) Video footage showed my feet still landing out in front, which basically pushes the shock into your hips to absorb rather than a bent knee directly underneath your weight with a lot more cushion for the impact.   I also had pelvic tilt which caused my right knee to cave inwards during footfall, and then kick out at the end.  This is likely a result of forward footfalls, as well as weak glutes that aren’t keeping my knee aligned straight.  So increasing mileage with improper form was a recipe for disaster.  Shoes can exacerbate your poor running form by being too cushy because it allows you to land on your heel, which normally would hurt.

It’s All in the HipsFoot strike, the darling of minimalism, is overrated. Good form starts with the pelvis and the glutes.“The foot is really just the end of a big kinetic whip–the leg. Core and hips are where every runner should be starting if they are really concerned with optimizing their form, maximizing their speed and minimizing injury potential.”

What Does Good Running Form Feel Like?
The power in your stride should come during the drive phase. Too many runners try to extend their stride by reaching forward with their leg during the swing phase; instead, you want to focus on driving your leg straight behind you using your hips.

Also, this great video on foot placement.  Even just walking around, my right foot ends up pointing outward, which is exacerbated when I run and contributes to the knee drive inwards.  Rebuilding the feet, part 1 with Brian MacKenzie

Weak and inflexible hips and glutes contribute to ITBS.  I even wrote a post a few years ago about my hip flexors being sore after sprinting and being confused by it.  And I had a groin strain while training for my triathlon a year ago after I jumped off a cliff.  Why? Weak hip flexors! This has been an issue for me for years and I didn’t work on it.  I figured with all the strength training and kicking I did with my other sports that it would be enough.  But it wasn’t.  It is not enough to just strengthen your muscles around your hip either. You need to stretch, stretch, and stretch some more.  When you start to feel pain,  the solution is not just rest, although that is extremely important, but to address the structural issues that contributed, which usually is tight and weak butt and hips.  Your body needs to be in proper alignment, and to also decrease tension in the muscles.  If your muscles are tight and in a constant state of tension, they are working in overdrive, and not functioning properly.  Articles do rightfully say that the IT band is the consistency of a tire, and can’t be stretched.. yes, but the muscles around it can, and massaging and foam rolling can release tension.  As the glute and hip muscles are the primary movers for driving your leg forward and to keep your knee in proper place while running, if you are out of alignment, or these muscles are weak or are not being activated, your secondary muscles end up being used.  Correct diagnosis is important.  I went to see a sports therapist and we did strength and flexibly tests and he said I had extreme tightness in the hips so that is what I am focusing on every day now.  Stretching and strengthening and foam rolling.  Even though there doesn’t seem to be a whole lot of real science behind foam rolling in general either, but I realize that not everything is even being studied.  It’s not that science has disproven it, it’s just that there hasn’t been much done to prove it.  At this time, science doesn’t even fully know what a ‘knot’ is, so how could it be studied definitively how to release tensions and knots through foam rolling.  It can’t. I figure if top athletes do it and recommend it, it can’t hurt to try it. Below are much better articles explaining more about IT Band Pain:

Iliotibial Band Syndrome: Cause, Cure and Your Core
“During flexion and extension of the knee the iliotibial band has historically been thought to rub over the femoral condyle creating irritation. There is significant doubt about this being a true “friction” created syndrome. ITBS, in most cases, does not seem to be friction syndrome with a “popping” of the tendon over the femoral epicondyle.

Running Competitor 10 exercises to treat IT band Syndrome

Pain Science: IT Band Pain


About Musings over Coffee

Fitness enthusiast. Love to travel, mess up recipes, ponder random things, get riled up about the news, all of which nearly always coinciding with one of my favorite things in the world: Coffee.
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