IT Band Syndrome

Iliotibial band friction syndromeIT band syndrome is a condition which causes pain on the outer knee. It is sometimes also known as runner’s knee (but so is patellofemoral pain syndrome – so make sure you distinguish which one you are talking about!)

Symptoms
The symptoms of IT band syndrome usually start during or just after a run. They include soreness on the outside of the knee joint which is probably tender to touch. After a day or two the pain tends to subside, but usually returns at around the same distance into your next run! If you continue to run the pain may start earlier in the run and last longer between training sessions.

What is it?

The IT Band is a long, thick band of fibrous tissue which runs down the outside of the thigh, from the outer hip to the outer knee. It is an attachment point at the top for the Tensor Fascia Latae and Glute (bum) muscles and attaches to the lateral condyle of the Femur, the lateral Patella and Tibia on the outer knee. Its role is mainly to stabilise the knee joint but it also aids the outer hip muscles in abducting the joint (moving the thigh out to the side).

There are a couple of possible causes for the irritation the IT band causes on the outer knee. The traditional cause is thought to be the lower portion of the band on the outer knee repeatedly flicking backwards and forwards over the lateral femoral condyle.  Every time we bend and straighten the knee, the band moves in front of (when straightened) and then behind (when bent) this bony prominence. More recently, a compression theory has been put forwards which suggests that the band causes compression of the tissues under the distal end  – including a bursa.

Either way, biomechanical problems cause irritation of the structures surrounding the IT band’s lower end and insertion.

Why Do Some People Get it and Others Not?

There are several different reasons why one person may develop IT Band Syndrome and why someone else may not. Historically therapists have focused on how tight the IT Band is, however tightness in the band is now thought to be a myth. The band itself has no elastic properties and so apparent tension in this region is thought to come from the muscles which insert into the upper part of the band – the TFL and Gluteus Maximus.

The cause of the condition is thought to be biomechanical, i.e. down to the way we move. As mentioned above, the IT Band assists the hip abductor muscles such as Gluteus Medius. Runners notoriously have weak hip abductor muscles due to the lack of sideways movements in their sport (unless they take part in other, less linear sports as well). This weakness places more stress on the IT Band as it tries to assist the weak abductors.

There are other factors which can play a role and these include training errors such as increasing training distances / times too quickly as well as a sudden increase in up and downhill running. Whilst tightness in the IT band is not thought to be a direct cause, some people do naturally have wider IT bands which can predispose them to the condition.

IT Band Syndrome Treatment

The initial focus of treating this condition should be relieving pain and inflammation. This can be achieved with rest (from running and anything else which aggravates the pain) and the application of ice or other forms of cold therapy. Apply an ice pack for 10 minutes every 1-2 hours initially (or as often as possible). This should continue for 3 days or until pain has eased. Your Doctor may also prescribe anti-inflammatory medications such as ibuprofen.

Don’t be tempted to return to running as soon as pain is gone on a day-to-day basis. The chances are it will only return. Instead you need to focus on detecting and correcting the cause of the injury which usually involves correcting muscle imbalances with stretching and strengthening exercises.

Stretching

There are plenty of exercises out there which are branded ‘IT band stretches’, but in reality, you can’t stretch the IT band. It is a non-elastic structure. Many people will use a foam roller to try to increase the pliability of the IT band. I’m not really sure about the effectiveness of this, but if you want to give it a go it can’t really do any harm.

Foam rollers are cylindrical pieces of dense foam which are used for self-myofascial release (a type of self massage). Foam roller massage can be pretty uncomfortable, or just downright painful if we’re being honest, so just do as much as you feel you can bare at any one time.

You may be better off saving yourself some pain and just focusing on stretching the Tensor fascia latae muscle (it is this muscle actually being stretched by most IT band stretches), hip flexors and glute muscles, as well as the hamstrings and quads if they are tight.

To really increase the flexibility of a muscle group, stretching once a day isn’t going to cut it. You need to be stretching AT LEAST 3 times a day, if not 5 times and holding each stretch for 20-30 seconds and repeating that stretch 2-3 times. “That’s a whole lot of stretching” you say? Yes it is, but it needs doing!

Strengthening

As mentioned above, weak hip abductors are a common cause of this. An excellent exercise to start with is the clam exercise:

  • Lying on the other side, ensure the top hip is directly over the bottom one and not rotated back or forwards. The knees are bent to a right angle and feet together.
  • Keeping the feet in contact, the top knee is raised up, away from the bottom knee as far as is comfortable and without cheating!
  • By this, I mean rolling the hips backwards to enable more movement at the hip. The idea of this exercise is to isolate the hip abduction movement of the hip to strengthen the Gluteus Medius.
  • Ensure the lower back and pelvis are kept still throughout. Lower the knee back down, rest and repeat.

As with all exercises this should be performed slowly, under complete control and with no pain. Start with 2 sets of 12 reps and gradually build up to 3 sets of 20.

Another hip muscle strengthener is the hip hitch:

  • Standing sideways on a step with the foot of the resting leg is off the step and all weight in on the leg to be worked.
  • Then, the free foot is lowered down as low as possible towards the floor, keeping both knees straight – hint, the movement should be coming from the pelvis.
  • The foot is then raised back up by levelling the pelvis again. After a few reps the hip on the standing leg will start to ache as it is these muscles which are working to pull the pelvis back to neutral.

Again, start with a relatively low number of reps and build gradually.

Other exercises of note include the single leg bridge and the squat with a resistance band around the knee.

Returning to Running

It is so tempting once daily pain has cleared, the knee is not tender to touch and you have been religiously stretching, rolling and strengthening for a couple of weeks to rush straight back to where you were before injury. But don’t fall into this trap!

Don’t even think about trying to run until you have a) no pain at all, b) seen an improvement in both your flexibility and strength and c) you can manage a few long walks with no knee pain.

If you can confidently say yes to all three of these points, then you MAY be ready to return to running. Start off with a very short jog. 10-15 minutes tops and of course, STOP if you feel any pain. It may be advisable to start back on a treadmill if possible at it is much easier to stop if you need to and you are at less risk of carrying on if pain occurs just because you need to get home!

If this first run goes to plan, ice when you get home and rest for another 3 days. Continue with your exercises. If all is still well, try another short run of about the same distance and again have 3 days rest. Repeat this another 1-2 times before increasing your running time by 5 minutes. Again, do this time for 3-4 sessions before increasing time again. Carry on in this fashion until you are back to your usual distances.

 Iliotibial Band Syndrome Recovery Times

As with most overuse injuries the answer to the question ‘how long will I take to recover?’ is one of those how long is a piece of string questions. The answer depends largely on how bad your case is. Those caught early with only mild symptoms during long runs will recover a lot quicker than those more severe cases where a strong pain develops almost as soon as you start running. A mild case may mean you miss a couple of weeks of training. A severe case could mean a lot, lot more.

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