Prevention and Treatment of IT Band Syndrome

Unlike most overuse injuries, IT band syndrome can sideline even the most experienced runners.

Iliotibial band syndrome (ITBS) is one of the most common overuse injuries from running. It can briefly be described as a pain and possible swelling on the outside of the knee. But there are a lot more details that go into the development, care, and prevention of IT band syndrome. Many overuse injuries often occur in only the newest of runners. But with IT band syndrome, everyone is at risk, no matter how experienced a runner may be.

Anatomy of the Iliotibial Band

To understand what Iliotibial band syndrome is and how it occurs, the first step is learning some basic anatomy. The iliotibial band itself is a ligament that runs down the outside of the thigh. It begins in the iliac crest in the pelvis, which is the outermost winged edge of the pelvis. The IT band passes through the hip joint as well as the knee joint, and ends at the shin bone, also known as the tibia. The IT band is connected to the knee, where it can help with stability in the knee joint and throughout the leg.

However, there are several other muscles in the legs that are meant to help create stability as well. The gluteus medius is one of these. The gluteus medius is the muscle situated on the outside of your pelvis. This muscle is also known as a hip abductor, meaning it’s responsible for moving the leg out and away from the body. The body uses hip abduction to give stability to the knee when running or walking. The tensor fascia latae, situated at front of the hip joint, also works with the gluteus medius and is attached to the IT band.

What Makes an Angry IT Band

To put it simply, IT band syndrome occurs when the IT band rubs against the knee, causing swelling and pain at that location. The IT band can also become irritated if it gets stretched too thin. This happens when the leg gets turned inward repeatedly, pulling the IT band towards the knee. Runners, old and new, might be causing this inward turning by several means. For one, old or ill-fitted shoes will fail to give runners the right support. In any sport, but especially in running, good shoes are incredibly important. They build the base of your posture and technique, and can make a world of difference in how healthy a run is.

Other causes for the leg turning inward include downhill running and track running. If you’re hill running without much experience or without the right conditioning, your alignment might be off. Likewise, if you go track running without changing direction, you’ll constantly place stress on one leg at one angle repeatedly.

Fatigue can also cause the leg to turn inward and the IT band to rub against the knee. However, fatigue and weakness can both contribute to another series of events that can cause iliotibial band syndrome. Remember the gluteus medius? Even though it located in the sides of the hips and not the legs, it is still really important in running. This is because of the role it plays in keeping our knees stable when we’re running or walking. But unfortunately, the gluteus medius is commonly under-conditioned. Runners and other athletes often fail to give this muscle the attention it needs. As a result, when running, the body goes to plan B for stability, which is the tensor fascia latae. But the tensor fascia latae often can’t handle the burden of stability on its own, so it calls upon the IT band for extra assistance. As this happens repeatedly, the IT band gets stressed and overused, causing Iliotibial band syndrome.

How to Not Get Hurt

Now that you’re aware of the anatomical causes of IT band syndrome, it will make sense to hear that one of the best ways of preventing this injury is with strength and conditioning. And that doesn’t just mean walking a half a mile before you start running—though you should do that, too. To really protect yourself against the possibility of IT band syndrome, you need to strengthen from the calves up to the core. Our core helps us stay balanced and stable through the spine and into the hips. Stronger hips, as we have learned from our lesson on the gluteus medius, mean more protection for our knees. Choose exercises that target the gluteus medius specifically, like side leg lifts. Laying on your left side, raise the right leg up to 45 degrees, and back down. Repeat.

You will also want to maintain flexibility in these areas. Stretch the calves, the hamstrings, the quads and the hips on a regular basis.

When you first start to notice even the slightest pain in your IT band, or at the side of your knee, listen to your body. Take a break from running for a couple of days, or decrease your mileage as necessary. If you pay attention to your body, you may be able to prevent any real injury. Be sure that you’re running on flat roads. If you’re track running, change directions regularly.

What to Do If It Happens to You

In most cases, Iliotibial band syndrome is an acute pain, meaning that it’s short-term. Acute pain is like a warning signal that lets us know something is not functioning properly. But if you don’t listen to your body and make the necessary changes at the first sign of IT band syndrome, or don’t rest long enough, it can become chronic. Chronic pain lasts longer than acute pain, and is more serious.

Avoid this by resting your IT band. While you’re taking a break from running, if it’s comfortable for you, cross-train with biking, swimming, or rowing. Be sure, too, that you work on strengthening and stretching, but do so gently and with time. A few days in, you might benefit from some gentle massage and careful stretches. Only in the worst and rarest scenario does IT band syndrome become serious enough to require surgery. For most runners, resting, strengthening or changing shoes or route can solve the problem and get you to feeling back to normal.

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