Iliotibial Band Syndrome (also known as ITBS or IT Band Syndrome) is one of the most common causes of knee pain for runners.
ITBS is an inflammation of this large band of connective tissue (the iliotibial or IT Band) that runs along the length of the thigh, according to Jordan Metzl, M.D., a sports medicine physician at the Hospital for Special Surgery in New York City and creator of the Runner’s World’sNew IronStrength workout. It begins on the outside of the hip and continues down to the top of the shin. The main function of the IT band is to stabilize the knee, assist with inward rotation, and help with hip abduction.
If you’re experiencing IT band syndrome, use this three-phase IT band treatment plan to reduce inflammation and strengthen the area in question. When pain is an issue for several days and does not get better with the treatment plan below, it's time to see the doctor.
Step 1: Reduce Pain and Inflammation The initial phase focuses on reducing pain and inflammation and increasing mobilization of the IT band. Rest, ice, NSAIDs, and topical anti-inflammatories are all effective in this initial phase. Occasionally, a corticosteroid injection can help to reduce the pain and enable one to move on to the next phase when used judiciously with the understanding that the injection is not curing the injury.
Step 2: Massage and Stretching Treatment progresses by using deep-tissue massage, a necessary step before moving on to strengthening. Experts recommend frequent massage: every day for elites and two or three times per week for recreational runners. Of course, it’s not realistic to spring for a professional massage several times a week, so a foam roller or similar self-massage tool can work just as well. Slowly roll all the way from knee to hip. Maintain fitness with cross training that does not aggravate the condition. (If it hurts, try something else.) After the pain subsides, add stretching while continuing deep tissue massage.
Step 3: Strengthening Begin strengthening the muscles of the leg as soon as the exercises below can be performed without pain. If you have access to an AlterG treadmill, that may also allow continued running during the rehabilitation phase.
Follow the instructions below for each stretch and exercise. You will need an exercise band, a mat, a medicine ball, and a box or step.
Because the iliotibial band is a connective tissue and not a muscle, you can’t really stretch it (or it would take too much force than you are capable of). But that “tight” sensation can be alleviated by stretching the surrounding muscles. This move stretches the tensor fascia latae, a muscle that runs across the hip and outside of the leg. Cross the injured leg behind the other leg and lean toward the uninjured side. First, stretch with your arms over your head, creating the shape of a bow from ankle to hand with the injured ITB on the outside, then bring your arms down to touch the ankle on the inside of the bow. Hold for 15 seconds and repeat 10 times. Perform 3 sets a day.
Place a resistance band around your legs just above the knees and start by lying on your left side with head resting on left arm, knees bent and stacked. Slowly draw right knee up toward ceiling to open legs like a clamshell. Perform the exercise slowly with emphasis on good form. Build up to 3 sets of 10 repetitions on each leg. When this exercise becomes easier and the leg remains pain-free during the process, you can move on to more advanced strengthening.
Start by lying on your left side with legs straight and feet stacked. Lift your right leg straight up, then extend the leg backward in that plane, move it forward, and then return it to the starting position. Form is very important. Check that you have a straight line from shoulder to ankle with the top hip slightly in front. (Do not let the top hip rotate backward.) Perform the sequence slowly with toe pointed down. Build up to 3 sets of 10 reps for each leg. Once you can handle that with no pain, make the move harder by lifting body into a side plank position with shoulder directly over elbow and hips lifted as shown. Build up to 3 sets of 10 reps for each leg.
Start standing and shift weight to right leg. Balancing on right foot, send hips back and bend right knee to lower one-quarter of the way down into a squat. Make sure the knee stays straight over the foot and does not collapse inward. Extend arms straight out for balance.
After you have mastered the straight quarter squat, make the exercise more challenging by mimicking running form, extending the unsupported leg behind you and bringing it through to lift the knee in front of you. Ultimately, work your way up to touching the ground in front of you on the forward lean. Then you can progress to holding a medicine ball overhead.
When strong enough, eccentric strengthening works the hip abductors in the same manner in which they function during running. Stand with left foot on a step or a stair, and let the right foot hang off. Place hands on hips for balance, then raise the other foot by lifting your hip on that side, while taking care to stay in a straight, upright position. Slowly lower the hip to the bottom of your range of motion, while staying upright. Perform 10 repetitions on each side and build up to 3 sets.
As you get stronger and your symptoms subside, test the injured leg with short runs that can be extended as long as the pain is not causing a limp or any compensation. Strides can sometimes be performed early in the treatment phase shorter and faster running often does not make the injury worse. Recovery time depends on many factors such as the length of time you have been injured and biomechanical aspects of your stride. Continue strengthening after you have resumed training to prevent further episodes.
Brian Fullem serves on the Board of the American Academy of Podiatric Sports Medicine and practices in the Tampa, Florida, area.