Runners Beware: IT Band Syndrome Can Haunt You

The weather is changing and avid runners are anxious to get off of those treadmills and begin running outside as the snow and ice begin to melt.  As people begin to train for races or start running for pleasure, they may not be aware of training principles and proper progression of distance and time of runs. Being unaware of properly progressing your runs or exercise routine can cause injury.  Even if you have been running a certain mileage for awhile, your body may not be strong enough to handle it if you are not performing a regular strengthening regimen.  Once your muscles get fatigued, your body can begin to compensate for tired muscles and cause your body mechanics to change eventually giving rise to injury.  Several injuries can occur, however, today I will specifically be discussing the ugly Iliotibial (IT) band syndrome that causes runners to have excruciating hip and knee pain. 

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As displayed above, the long white band of tissue on the outside of your leg is your IT band.  IT band syndrome is caused when your IT band, the band of tissue that attaches from your ilium (outer pelvic bone) to the outside of your tibia (shin bone) and patella (knee cap), becomes taut and can cause lateral tracking of your patella or friction (rubbing) on the top or end of your femur (thigh bone).  This can cause diffuse pain and tenderness in the hip region or the outside of your knee.  If irritated severely enough, you may feel like your knee is "locking" when trying to bend or extend your knee or you may feel like your hip is "popping" or "snapping".  This whole phenomenon can be caused by muscle strength and flexibility imbalances, as well as with fatigue during prolonged running causing faulty mechanics that lead to injury. 

If this sounds like something you're experiencing, there are some home remedies you can try.

1.  First and foremost, ice and rest are ways to help relieve immediate pain. Icing for 10-15 minutes every couple of hours can help relieve inflammation. Also, if you are able to take ibuprofen, it is best to take that with food for a few days as directed by the bottle to help reduce inflammation further.  If unable to take ibuprofen, other pain relievers can help with reduction of symptoms.

2. One of the best things to do for this injury is using a foam roller to massage the IT band to help stretch out and loosen up the tissue.  Let me warn you that this is painful and most people aren't fans of this exercise, however, I promise that it gives good results.  If you or your gym do not have a foam roll you can purchase one for a reasonable price at Amazon.com, or it is ok to use a tennis ball, coffee can, basketball, PVC pipe, or other object that is somewhat dense and able to roll along your leg.  The harder the object is, the more massage you will get, however, it can be pretty painful if you start with a very dense object like a PVC pipe or coffee can.

*Start with the foam roll positioned under your hip on the painful side (as pictured above) and begin to slowly move your body upward so the foam roller rolls down the side of your leg towards your knee.  You can use your other foot and arms to help you move along the roller. 

*Once you have reached the outside of your knee (as pictured above), you can begin rolling back towards your hip.  You will repeat this slowly 10-15 times.  It is wise to perform this on both legs so that you can keep both IT bands from becoming tight.

3.  Strengthening of the gluteus medius (hip abductor) and gluteus maximus (buttocks) muscles is highly recommended for people with IT band syndrome.  If these muscles are weak or fatigue during running, it can cause your pelvis to be unstable with running and cause your knee to rotate inward when your foot hits the ground.  This inward rotation of the knee can cause not only your IT band to get stretched and irritated with every step, but can also cause further knee and foot injury.  Below are some great exercises you can perform to strengthen your glutes!

*Side Stepping with Band: If you have a theraband (elastic band) that you can tie around your ankles, this exercise is great to work the gluteus medius.  You will perform a slight knee bend, keeping your butt back and preventing your knees from going over your toes, while you step sideways across the room with the band. It is important to make sure your knees do not rotate inward with each step and that you keep your toes facing forward.  This should be performed with 15-20 steps in each direction once a day. 

*Sidelying Leg Lift: This exercise can be performed anywhere and is great to activate the gluteus medius. Lay on your side with your bottom leg slightly bent.  Keep the top leg straight and lift it straight up and down, making sure that the leg does not come forward at all.  To get good gluteus medius activation, it is recommended that you keep your leg slightly extended while you lift it.  Perform a couple sets of 20 repetitions once a day on each side.  If you have ankle weights, you can add one to three pounds to progress this exercise. 

*Singe Leg Bridge: The single leg bridge is a great way to isolate your glutes.  Bend one knee in towards your chest (or you can hold it out straight with your knee extended) and bend the other knee up and keep your foot on the ground.  Keep your stomach muscles nice and tight while slowly lifting your butt off of the ground and back down.  Be sure that your pelvis remains level the entire time. Peform a couple sets of 10-15 repetitions on each leg once a day.  ***Please note that this exercise is advanced and may be too difficult for some people.  If this is the case, start by keeping both feet on the ground and lifting the butt up with both legs, instead of one.***

*Body-Weight Squat (with or without theraband): Another great glute strengthening exercise is the body-weight squat.  This exercise, if done correctly, should not cause pain.  If it does cause knee pain, please do not perform it or contact a physical therapist or personal trainer for advice.  Start with your feet shoulder width apart and your toes facing forward.  Slowly squat down, keeping your butt backwards and your knees in line with your feet.  The key thing to remember with squats is that your knees should not go inward or over your toes.  You can stick your arms out in front of you or hold onto a sturdy object for balance if needed.  If you have a theraband, you can place it around your knees for added gluteus medius activation.  The band will want to pull your knees inward and you must resist it in order to keep them in good alignment.  Perform a couple of sets of 15-20 repetitions once a day.

It is important to note that the strengthening exercises should not cause pain.  You may feel a slight burning or achy sensation in the muscles when the muscle is working during the exercise, however, this is normal and should not be a sharp pain.  Also, with any new exercise routine, it is normal to have muscle soreness up to 24-72 hours after exercise.  To help with reducing this soreness, it is best to keep moving around, stretch, and drink a lot of water to help flush the muscular tissues. 

I suggest trying these exercises to help relieve your pain and take a break from running until your pain subsides. You can perform other non-painful aerobic activity in the meantime. If your pain does not relieve itself within a few weeks, it is best to seek help from a physical therapist.  If you do not feel comfortable trying these exercises without the advice of a professional, feel free to seek help right away.  Physical therapists can provide pain and inflammation relieving strategies such as ultrasound, electrical stimulation, and iontophoresis, as well as help mobilize the soft tissue with manual therapy and massage techniques and give further education on stretching and strengthening exercises you can perform to decrease and get rid of your symptoms.  We can also take a look at your feet and suggest types of shoes you should be wearing, assess your running technique and provide any helpful hints on improving your form to decrease likelihood of further or future injury, and give ideas on things to avoid or how to progress your training regimen. 

If you think you have IT band syndrome or if you just want your running form or shoewear assessed professionally, please give us a call today!

608-222-2325