A Runner’s Guide to Diagnosing and Treating Iliotibial Band Syndrome
Are you experiencing pain on the outside of your knee and/or hip? Did you just see your primary care doctor and they diagnosed you with a case of “ITBand Syndrome?” OR maybe over the last few weeks you’ve had pain on the outside of your knee every time you stand up from your chair or go down the stairs. After going down the GoogleMD spiral, you believe it could be your ITBand, and you click on a video for how to “stretch” your ITBand. I am not stalking you, but yes I know you are guilty and believe me there is no judgement. Only mild amounts of head shaking and face palms. Here is your REAL guide to understanding the ITBand, when it is at fault, and what to FINALLY do about it.
What is the ITBand?
Let us begin with discussing what the ITBand actually is in its anatomical structure and location. The ITband is a long, thick band of fascia.
***Side bar: What is fascia? Fascia is a sheet of connective tissue that works to stabilize, enclose, and separate muscles/internal organs so movement amongst the structures can occur while providing protection. In addition, fascia is said to contain many nerve endings helping us sense where our body is in space so we don’t have to look at our feet while we run. If we did not have fascia between our muscles and organs, then damage would occur from friction between structures during movement. End side bar***
Now, the ITBand is made up of said fascial tissue; however, it has a different composition of elastin and collagen fibers making it a strong, thick band useful for absorbing and transferring force without too much deformation. Similar in a way to the achilles tendon, it acts as a “spring-like” mechanism for storing and releasing elastic energy while also providing stabilization of the joint (knee and hip in this case). The ITBand runs from the iliac crest (pelvis), Gluteus Maximus (muscle) and Tensor Fascia Lata (muscle) all the way to the outside of your knee joint. It passes over the lateral femoral condyle (the bottom of your thigh bone) without true attachment and finally secures itself to Gerdy’s Tubercle on the lateral aspect of the tibia (shin bone).
FUN FACT ALERT: Gerdy’s Tubercle is a smooth facet on the lateral (outside portion) aspect of the Tibia bone (shin bone), which was discovered and named after a French physician, Pierre Nicolas Gerdy, in the 1800’s. He is exactly as you are imagining – white, male, and whose looks resemble a love-child between George Washington and Julia Child:
FUN FACT (CONT.): Due to the ITBand’s insertion on Gerdy’s tubercle, it actually has no bony attachment along the femur or outside portion of the knee joint; only the patella. Therefore, it has the tendon-cy (puns intended) to shift back and forth as your knee flexes and extends. AND – since it does attach to the patella, you can bet your boots the ITBand is a sneaky culprit of “poor patellar tracking issues.”
Why Does ITBand Syndrome Happen?
The ITBand attaches to many muscles/joints and can be influenced by restriction, over-activation, or damage in any of these surrounding structures. For example, if the Tensor Fascia Latae becomes shortened (or tight) as is common with sitting all day and having an anterior pelvic tilt, then it pulls upward on the ITBand. If we do not stabilize the ITBand by maintaining a neutral femur position using our glutes, then the ITBand again becomes taught adding increased shear forces at the hip and knee joint.
The reason why this injury is referred to as a “friction” syndrome is in part due to the repetitive front to back motion of the ITBand during hip or knee flexion and extension. As you bend your knee, the ITBand moves slightly posterior (backward). The opposite occurs when we straighten our knees and the ITBand moves towards the front. As it moves front to back, it can glide along the bottom portion of your thigh bone as well as along your hip joint (where a bursa lives). You can imagine that over time, this repetitive motion creates friction at either (or both) joints leading to pain, inflammation, or an unhappy bursa.
This does not only happen in runners. In fact, it has been found to occur in heavy weight lifters, climbers, and cyclists (2x the incidence!!). The biggest contributing factors to developing ITBand Syndrome are:
Repetitive knee and hip flexion.
Tight hip and quadricep muscles.
Weakness in the glutes, hamstrings, abdominals and quadriceps.
Overtraining or increasing training too much/too soon by volume, intensity, or elevation (i.e. trail running or hiking).
Over-striding, low cadence, and other poor running mechanics
What Are the Symptoms of ITBand Syndrome?
These words always sound so intense and dramatic, but indeed describe the sensation one feels with ITBand Syndrome:
Stabbing
Stinging
Sharp
Tight
Achey
Freaking Annoying as All Heck
The pain is generally felt on the outside of the knee joint and/or the side of your hip joint. Swelling can occur in the initial stages of healing and inflammation, and it is common to feel a “snapping” sensation over the knee/hip as you bend and straighten it. Activities like running, long walks, stairs, jumping, squatting, or standing up from a seated position will be painful; however, your pain may not appear until after activity ceases depending on the severity of the injury. Why? Well, as you warm up your body, your tissues become warmer, looser, and more lubricated while an increase in adrenaline is distracting from any active pain signals. As soon as you stop exercise, the inflammatory process begins (this is a good thing by the way) and the increased swelling creates pain. It’s your body’s way of telling you something is wrong and it is working hard to fix it.
Sometimes this pain/ache can be worse when you wake up in the morning, as the inflammation process continues and your joints have been stationary for hours overnight. Then, as you start to move for the day, the pain reduces and you can move your hip and knee with less irritation. Movement in general helps reduce swelling as the muscles work like pumps to flush the built up fluid out of your system. This is one reason why it feels better after you start moving for a bit. Gently moving, mind you. Not going out for a 6 mile run at 10K paces. Don’t do that. I’ve done that.
Don’t do that….
How Do You Treat ITBand Syndrome?
Iliotibial Band Syndrome can be a formidable obstacle for runners and athletes, causing pain and frustration. Let’s explore effective treatment strategies to help you overcome ITBand Syndrome and get back on the track with confidence, less pain, and more of what you love to do. Whether you're a seasoned athlete or a novice runner, understanding how to treat ITBand Syndrome is crucial for a swift and successful recovery.
Rest and Activity Modification: One of the most critical aspects of ITBS treatment is giving your body time to heal. This may involve temporarily reducing or even ceasing your running activities. Consider low-impact exercises, such as swimming or cycling, to maintain your cardiovascular fitness without aggravating your knee.
Stretching and Strengthening: Incorporating specific exercises into your routine can help alleviate ITBand irritation and further injury. Exercises could include:
Bridges
Standing Clamshells
Banded Side Steps or Monster Walks
Single Leg Squats
Planks
Hamstring curls
Stretching the hip flexors, adductors, and quads if restricted
Proper Footwear and Running Form: Make sure you have appropriate running shoes that provide the right level of support and cushioning. Additionally, work on your running form to reduce stress on the ITBand such as increasing your cadence, improving your forward lean, or focusing on foot strike.
Anti-Inflammatory Medications: Over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs), like Ibuprofen, can help reduce pain and inflammation. Consult your healthcare provider before using them.
Icing: Applying ice to the affected area can help alleviate pain. Ice the outside of your knee for 15-20 minutes every 2-4 hours, especially after running.
Alternative Therapies: In more severe cases, your doctor might recommend corticosteroid injections, shockwave, PRP injections, or class IV laser therapy to reduce inflammation and allow the tissues to heal.
Taping or Bracing: Typically, a brace is used when we require stability and/or reduced motion to help protect a joint or damaged tissue. In the case of ITBand syndrome, you will see knee braces (either sleeve or strap) that claim to help reduce pain from ITBand Syndrome. This may be true in the short term temporarily, but will not help with the long term healing of ITBand Syndrome and may even make your injuries worse if you don’t focus on the other strategies to heal it properly. KT Taping may be a nice option for reducing pain and inflammation, but again, is a short term temporary solution and not helpful for long term success.
ITBand Syndrome can be a frustrating and painful condition for runners, but with proper diagnosis, treatment, and prevention, you can get back to your favorite activity. Remember that everyone's body is different, and what works for one person may not work for another. Always consult with a healthcare professional to create a personalized treatment plan that suits your needs. Patience, consistency, and a commitment to recovery will help you overcome ITBand Syndrome and continue your running journey.