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IT BAND SYNDROME

What is the main cause of running injuries?

When taking all sports and activities into consideration, the highest ratio of overuse injuries comes from running.

Running injuries occur from an abundance of intrinsic and extrinsic factors (internal and external).

Extrinsic factors are caused by external forces. They include:

  • Sudden increases in training volume

  • Poor strength and conditioning methods

  • Over training - not taking active rest days

  • Incorrect training techniques

  • Poor dietary habits

Intrinsic factors occur naturally. They include age and biomechanics.

Unfortunately, these factors can play a significant role in how running injuries are caused. While there is nothing we can do about the aging process, we can certainly analyse our body type and physique when fixing our running form.

These factors involve height, joint and muscle structure when affecting our technique. The best method of correcting this issue is by conducting a personal assessment called a gait analysis. This analysis confirms if your running form is impacted by any stressful forces against your body.

So how do most running injuries occur? The answer to that is running.

Incorrect form is the primary contributor for most issues, accompanied by bad habits and preparation off the track.

Let’s take a look at a common running injury that many runners are likely to encounter as a result of these factors.

If you’re experiencing this problem, perhaps this guide will help you to identify, prevent and correct IT Band Syndrome.

National Academy of Sports Medicine: IT Band Syndrome affects up to 12% of runners.

What exactly is Iliotibial Band Syndrome? (ITBS)

IT Band Syndrome (ITBS) is an overuse injury that affects the connective tissue located on the lateral side of the knee or thigh. This connective tissue originates at the pelvis (iliac crest) and runs down the lateral side of the leg until it crosses under the patella (knee) to attach itself to the tibia (shinbone).

It is said to be a recurring injury or syndrome due to the pain disappearing and returning sporadically. This pain will more than often reappear on the lateral side of the knee.

The IT Band is responsible for holding the supporting compartments of your knee in place. If it becomes weak, it can can have a negative impact on keeping these muscles functional and balanced. This chain reaction can ultimately affect “knee stability”. The IT Band plays a pivotal role in keeping our knee stable when performing its primary movements - flexion and extension.

This injury is very common for runners, cyclists, and various athletes who play sports on mixed or hard surfaces.

These activities require the knee to continuously flex and extend while being exposed to impact. If the patella is unstable, it might decide to shift out of position from its patellofemoral groove. If this happens, it causes a feeling that the knee is about to “give way”, forcing the athlete or participant to stop all activity.

What are the symptoms of IT Band Syndrome?

The pain from IT Band syndrome is spontaneous and can be often feel confusing for the person suffering.

There are many triggers that allow the pain to come and go.

In general, somebody will sense if their knee is about to “give way” if any activity feels too intense.

When the IT Band becomes tight, it causes friction when crossing under the patella and attaching to the shinbone. The first signs of this occurrence is swelling and inflammation around the knee. The immediate reaction to seek relief might be to flex and extend the knee joint excessively, or add compression by holding around the shinbone.

Fluid can start to build up, giving it that puffed look. When examining in the mirror, it’s easy to notice that one knee is significantly larger than the other. As a further attempt to reduce the pain, somebody suffering from ITBS might decide to sit down and take the weight off their foot. This can eventually lead to more irritation as the knee remains in a fully flexed position.

What triggers pain with IT Band Syndrome?

Here are a few activities that can cause pain or friction with IT Band Syndrome:

  • Walking up and down stairs

  • Sitting or standing in one place for a long time (Static Position)

  • Increasing speed while running or cycling

  • Running downhill

  • Weight bearing exercises (Squats, Lunges, Jumping)

What are the symptoms that onset:

  • Numbness in the shinbone (tibia)

  • Clicking, grinding or popping sounds (can be dull or painful)

  • Fluid building up inside the knee cap

  • Burning sensation and redness in the inured area

  • Confusion of the location of pain (pain can onset on the lateral side or beneath the knee)

The most severe symptoms are displayed when performing physical activity - either weight bearing exercises or increasing speed or load when exercising. This is when the knee will most likely experience the feeling of it “giving way”.

When performing squats, you’ll notice that somebody suffering from IT Band Syndrome will turn their knee inward as they lower themselves to the floor. Squatting beyond 45 degrees can be difficult for people experiencing advanced symptoms.

Clicking and popping noises becoming louder is a symptom when increasing speed during aerobic activity. This can lead to a daunting feeling that the knee is suddenly going to lose complete function.

Note: Symptoms for many running injuries are similar. Check out our article on Runner’s Knee to clarify the difference between IT Band Syndrome and PFPS.

What is the treatment for IT Band Syndrome?

If the issue appears and disappears, then how do you stop it from recurring?

It’s very rare for anybody to need surgery for IT Band Syndrome.

Usually, recovery is achieved by treating the injury by taking some simple steps.

Let’s take a look at 4 steps that help you recover from Iliotibial Syndrome:

1- RICE Procedure

Step number 1 is to exercise the RICE method.

The term RICE stands for rest, ice, compression, and elevation.

This procedure is a simple technique that reduces swelling, eases pain, and speeds up the healing process.

  • Step 1: Rest - This initial step is important for ITBS as the inflammation and swelling needs to completely settle. If these symptoms are still present during exercise or activity, the situation is only aggravated and made worse. This results in having to start the recovery process all over again.

  • Step 2: Ice - Ice is another procedure for reducing the pain and swelling. Make sure to cover an ice pack with a light towel or cloth to avoid frostbite. Apply the ice pack to the swollen area for 15-20 minutes. Repeat this routine every two to three hours for 72 hours after the time of injury. A bag of frozen peas works well as a substitute if you don’t have an ice pack handy.

     

  • Step 3: Compression - Compressing the swollen area with an elastic bandage will further prevent the level of swelling. This can be done using an Ace Wrap. This medical bandage does not constrict the area too heavily. If the bandage is too tight, it might disrupt blood flow and reduce circulation. Signs are numbness, tingling, loss of sensation and pain. If the bandage is applied correctly and you are still experiencing these feelings, contact your doctor for further assistance after 48 hours.

  • Step 4: Elevation - Lying on your back, raise the injured leg until its above heart level. Position your leg on a comfortable surface such as a cushion or the end of a sofa. This protocol reduces the throbbing pain and swelling in the extremity and improves circulation back to the heart. This increases blood flow to the injured area for active recovery. This is important to do when icing the injury.

    Article Of Interest:

    Anywhere Fitness: Can Sleep Help With Your Weight Loss Goals.

    This article provides tips on how to get quality rest - essential for effective recovery when suffering from injury.

2- Strength and Corrective Exercises

If you’re an avid runner, its likely you’ll encounter IT Band Syndrome at least once in your life. The chances are higher if you don’t practice your strength and corrective exercises. The impact from running affects more than just our knee joints. It also causes wear and tear to its supporting muscles.

Researchers at Stamford Health have found that having “weak hip muscles” contributes strongly to IT Band Syndrome. Having weak hips breaks the pattern of good running form. The gluteus medius is the main hip abductor and external rotator. When this muscle is weakened, the IT Band starts to become tight and loses its function. Poor running form, combined with a Tight IT Band, makes it difficult for our knee joint to absorb the impact of running. This can lead to several other injuries if not corrected.

Two pieces of equipment i recommend for training your Hips and IT Band:

  • Resistance Bands

  • Foam Roller

Great exercises to strengthen our Hips and IT Band: (Use a resistance band for Glute activation)

  • Side Leg Lifts

  • Seated Clam Shells

  • Bridge Exercise

  • Squats

  • Side Walk (Tighten band around your calf muscles)

  • Zig Zag Walk (Tighten band around your calf muscles)

  • Foam Rolling (From Hip To Knee)

Watch the sequence of these Hip and IT Band Exercises using resistance bands.

Watch this video on how to Foam Roll your IT Band.

How To Activate Your Hips During These Exercises

Side Leg Lift

  1. Lie down on your side with your legs extended out straight.

  2. Your lower arm can rest under your head. Your top arm can rest on your hipbone.

  3. Raise your top leg up while keeping the hip steady. Stay in that straight position and don’t rotate forward or backward.

  4. Lower your leg down and repeat.

  5. To engage your hips and it band, fit a resistance band just below the knee joint. To engage these muscles further, turn your foot downward (facing the floor) for the duration of each repetition. You will feel a lot more activation in your gluteal muscles.

  6. If you wish to make this exercise harder, attach an ankle weight to the top foot.

Seated Clam Shells

  1. Lying on your side, bring your knees together at a 45 degree angle. Place one foot on top of the other so they’re even stacked.

  2. Keep the lower hand behind the head or on the floor while the top hand rests on your hipbone.

  3. Engage your abdominal muscles by pulling your belly button inwards. This will support the stability of your spine and pelvis.

  4. Focus on keeping your spine in neutral position and don’t rotate forward or backward.

  5. Then performing a repetition, lift the top knee as high as you can towards the ceiling while keeping your feet stacked together.

  6. Lower your leg down and repeat.

  7. To engage your hips and it band, again fit the resistance band just below the knee joint. When you raise your knee as high as you can, pause for 1-2 seconds before lowering your leg. This helps to engage your TFL, IT Band and Glutes for longer. Strengthening all these muscles is important for knee stability.

  8. If you wish to make it harder, attach a weight pack around the top knee.

Bridge Exercise

  1. Lie on the floor with your back firm against the ground.

  2. Keeping your feet hip distance apart, point your toes forward, and keep arms firmly on the floor on both sides.

  3. Bend your knees and keep your feet flat on the floor as you bring them back towards your body.

  4. Using your hips, lift your body off the ground until your knees, hips and shoulders form a straight line.

  5. Lower your leg down and repeat.

  6. To engage your hips further, hold the contraction phase for 1-2 seconds while in that pencil like position when elevated from the floor. To make the exercise harder, add a resistance band just above the knee joints. When pushing upwards on the contraction phase, push outwards as well and squeeze your glutes inwards towards your body. This helps to add more contraction to the gluteus medius and minimus.

Squats

As mentioned earlier, weight bearing exercises are tricky to perform with IT Band Syndrome. The knee becomes highly unstable as we lower ourselves to the floor. The knee turning inward is a sign that we feel our knee is about to fail. For this reason, its important to always perform squats with the resistance band.

  1. First, make sure to attach a strong resistance band that fits just beneath each knee joint.

  2. Keep your feet shoulder width apart, with your toes pointing straight ahead.

  3. Keep your core engaged and tucked upwards, keeping a neutral spine at all times.

  4. Looking straight ahead, push back with your hips (like you’re sitting in a chair) and keep your heels planted on the floor.

  5. Lower yourself very gently. Try to go just beyond 45 degrees if you can. If you feel you can go a little further then try.

  6. Slowly elevate yourself back to original position and repeat.

  7. To perform this exercise to your best ability, push your knees outwards against the resistance band as you attempt to lower yourself to the floor. This will resist the temptation of your knee to move inward from ITBS and increase your range of motion. This is key for strengthening your IT Band and recovering from the condition.

Zig Zag Walk

When performing the side or zig zag walk, we are adding variations to targeting our TFL, Gluteus Medius and Minimus. If you have watched the video above, it is a very easy and straight forward exercise. Here is a few tips to maximise results from engaging these muscles.

  1. Attach a tight resistance band (small hoop sized band) around the ankles.

  2. Starting with your feet together, slightly bend your knees until they are at a 45 degree angle. Bring your body forward but engage your core to keep a neutral spine. This position adds a weight bearing effect to engage all the muscles in the lower extremities further.

  3. Step out with one foot at 45 degrees, bringing the other foot to meet it. Then repeat this movement on the opposite side. Repeat these steps left and right for the duration of the set. To make this harder, add a second resistance band around the calf muscles.

Foam Rolling - IT Band

  1. Lying on your side, take a foam roller and place your hip first against its surface.

  2. Extend the leg that is on the roller completely straight so that it comes off the floor.

  3. Cross the other leg out in front and place your foot on the ground to give support.

  4. Using the foam roller, roll your hip to your knee back and forth.

  5. Try to repeat this sequence back and forth for 20-30 seconds.

  6. Take a break and repeat again.

3- Change Your Training Regiment

Generally speaking IT Band Syndrome is an overuse injury caused from over training and lack of conditioning.

We can include many different factors that contribute to its existence, but knowing that consistent stress on the knee joint is the likely reason for injury, gives us an advantage to avoid this issue.

This is why its a good idea to change your routine if its becoming a constant problem. Try changing your running route or the terrain on which you are training. Include easy surfaces like running in parks opposed to hard gravel paths or the treadmill. Be a tactician in looking after your knee.

Remember to stretch after each workout, whether its running, cycling or a session in the gym.

IT Band Syndrome can be caused from an array of training programs. Stretching increases blood flow and range of motion in the joints and muscles. This keeps agonist and antagonist muscles from getting weak or imbalanced (example quadriceps and hamstrings). Keeping our muscles balanced in our lower extremities is essential for avoiding issues like ITBS.

One thing you might need to change in your training regiment is your running form. Having a professional look at your running gait can reveal why you are prone to injury. It could be a case that your stride is too short or too long. For cyclists, it could be a matter of adjusting your seat height. No matter what sport you perform, if this issue recurs, maybe its best to get your technique assessed.

4.  Shoes or Orthotic Issues

If you’ve been using the same running shoes for a long time, and you feel continuous pain, then you may want to consider making a change. There’s a good chance these shoes are offering no support for your knees or back.

Make sure to invest in a pair of running shoes, properly designed for this activity. Trainers that are made specifically for the gym should not be used for the purpose of long distance running. This can lead to knee and back injuries in the short term and even more severe health issues in the long term. Again, have a professional examine you if experiencing knee pain. They might recommend adding insoles to your running shoes or specific footwear for your needs.