Iliotibial Band Syndrome (ITBS) is a common complaint in runners with pain on the outside of their knee. The iliotibial band (ITB) starts at the top of the hip and attaches to the outside of the tibia, just below the knee joint. The tensor fascia latae and glute max both attach to the ITB near the hip. When they contract, they can place pressure on the ITB. There is also increased stress placed on the ITB during hip internal rotation, hip adduction, and knee flexion to about 30 degrees.
So…what is ITBS?
It was previously thought to be tightness of the IT Band. We now know that it requires far more force to deform the ITB (i.e. stretch it) than can be produced by stretching. Yes, that means your Theragun, lacrosse ball, or foam roller isn’t really doing the job here.
Unfortunately, the cause of ITBS is poorly understood. Many theories have been proposed. These theories include repetitive stress, weakness of knee and hip muscles, muscular imbalances, foot/ankle mechanics, running form, and even inflammation of the IT band due to friction. Recent research has even proposed that the IT band compresses muscles and nerves that lie beneath it, leading to irritation.
While strength and landing mechanics during running can influence the IT Band, a change in a training routine is present in the majority of runners experiencing ITBS.
So…how is it treated?
This greatly depends on the runner. If the runner recently increased their mileage or intensity, start by backing down to a tolerable milage per week. From there, gradually add mileage at a rate of <10% per week.
Landing with knee valgus (knee caving in) can lead to increased tension on the ITB. Assessing if knee valgus is due to motor control, knee strength, or hip strength (particularly hip abductors and external rotators) can help to better identify strength deficits that may have an impact on increased tension in the ITB during landing.
Then there’s a balance of calming down the symptoms while gradually improving strength and motor control. Progression will depend on the person’s tolerance to loading, training history and training goals.
If there is a lot of pain, a good starting point might be lower load, non-weight bearing exercises. These exercises would allow symptoms to decrease to an acceptable level. This may include side lying and open chain exercises. Uphill walking and running on a treadmill may be helpful during this phase to allow the individual to continue loading the knee without increasing symptoms.
Once symptoms have calmed down, we want to progress towards weight bearing positions for strengthening, since it’s more functional for running. Continue progressive overload strength training during this phase. Continue addressing motor control to progress towards higher impact exercises. Single Leg RDL, Single Leg Squat, and Bulgarian Split Squats are all good options for this part of your return to running.
As strength and motor control improves in weight bearing higher impact exercise should be incorporated. Plyometrics are a good option here. Some examples are Skaters, Single Leg Pogo Hops, and Single Leg Depth Drops. These will be coupled with progressive increases in running milage and intensity not to exceed 10% per week.
But, shouldn’t I take some time off of running to decrease the pain?
Simply taking time off of running is not the answer if you’re experiencing ITBS. It’s important to find a provider who can help you progressively overload your ITB to exceed your running goals.
If you’re experiencing ITBS and you’re looking for a provider in the D.C. area, reach out to us. If you’re not in the D.C. area, let us know and we’ll help put you in contact with someone who can help you out!