When you become a regular runner you become very well acquainted with parts of the body that you might not have known existed before you started pounding the pavements.
The plantar fascia – the band of tissue that forms the arch under the foot – is one such area, and the iliotibial band (IT band) is another. The reason that runners get acquainted with the parts is that both are annoyingly prone to injury. Because when something on your body starts hurting, you can be sure that you’re going to try to find out everything about it.
For all the info on IT band syndrome, including tips on how to prevent the issue ever arising, we spoke to Rebecca Christenson, a specialist musculoskeletal physiotherapist at puresportsmed.com.
What is IT band syndrome?
The IT band runs down the outside of your thigh, extending from the pelvis to just below the knee and plays a vital role in stabilising the knee during running. According to Christenson there are two main theories about what IT band syndrome is: a friction injury or a compression injury.
“Initially it was thought that that band can move forwards and backwards as the knee bends and straightens. Underneath that it may be possible to cause an area of friction, which might be what we thought of as ITB friction syndrome. But then, looking at some studies, there were questions about whether the IT band does move exactly like that.”
“Another theory is that there might be some compression created around the lateral aspect of the knee [the outer part of the knee], around the tibia [shin bone], and also the femur [thigh bone].
Either way, Christenson says, “it essentially relates to possible tissue irritation which may be inflammation”.
What are the symptoms?
As with most running injuries, the primary symptom is pain.
“It’s standard to have pain on the outside of the knee,” says Christenson. “It wouldn’t really cause pain anywhere else.
“You might have coexisting problems but if you don’t have pain on the outside of the knee by the knee joint line, you probably don’t have ITB syndrome.
“Sometimes it will stop someone in the middle of the run, but the pain can hit two or three hours later. You’ll stand up and find you can’t really straighten your knee, or that you want to keep it straight.”
What causes IT band syndrome?
“It’s definitely classified as an overuse injury,” says Christenson. “Training load – the progression of that, as well as intensity and volume – is relevant.”
Your running biomechanics can also play a big part in causing IT band syndrome.
“One of the biggest things – which leads into the possibility of the compression theory – is increased angle of hip adduction, or what you’d call hip drop. That’s when you’re running and the other leg drops down in relation to the weight-bearing leg, your pelvis drops towards the weight-bearing leg.”
How do you prevent IT band syndrome?
Keeping tabs on your training workload and adding in some strength sessions are your first steps for reducing the risk of developing IT band syndrome.
“I would certainly say that it’s useful to have two strength sessions a week,” says Christenson, “and always have at least one day off, ideally more than that.
“What you plan to do the next week should relate to what you’ve done in the previous three weeks. You’ve got to take into account your most recent training as well as your more long-standing training.”
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How do you treat IT band syndrome?
IT band syndrome is not an injury to try to run through.
“Unfortunately it does often require time out of running,” says Christenson. “Three to six weeks is not uncommon.”
“I’ve had patients who haven’t followed advice and have gone back earlier. The problem is you can often feel good walking quite quickly. You might have pain walking for two or three days and then you might feel good and decide to run a week later. In my experience that doesn’t often work. Even if you feel good walking, it often requires a greater period of time out of running to reduce that irritation.”
While you are resting you should take the time to examine your training load and also your running biomechanics. And when you do get back to running it’s vital to build up gradually, rather than going straight in with the training workload you had before the injury.
Can foam rolling help?
Bad news for fans of self-myofascial release: it’s probably not the tonic required for your IT band syndrome.
“I would say the proportion of patients where a tight ITB is the main driver of their symptoms is incredibly low – less than 5%,” Christenson says. Since a foam roller releases tightness it won’t be of much use.
In fact, overuse of the foam roller can have a negative effect.
“Sometimes I’ll have patients who massively overuse it and cause themselves irritation higher up in the IT band,” says Christenson.
How do you work on your running biomechanics?
It’s tricky to fix any biomechanics issues without an expert at hand, but strength work in the gym can help, especially if you do it on one leg.
“A lot of people will go to the gym and do leg presses and maybe squats but they’re never on one leg,” says Christenson.
“Single-leg exercises that are aimed at the glutes and the quads, probably with some resistance, are quite important if you’re a runner.”
Try single-leg squats for starters and check your biomechanics with a mirror.
“You’re looking for good alignment,” says Christenson. “Broadly you want the pelvis to be level, and you want your knee to be over your foot rather than deviating inwards or outwards.”
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If you are worried about your biomechanics is it best to see an expert?
“I think it’s really hard to self-manage,” says Christenson. “Unless you know what you’re starting with it’s hard to fix.”
On the plus side, if you’re consistent with your strength training to support your running, your bad biomechanics might never catch up with you.
“Even someone with bad biomechanics,” says Christenson, “if they’re sensible with their training and they’re strong I think they can get away with a lot.”