Iliotibial Band Syndrome (ITBS), also known as IT band friction syndrome, is a common overuse injury that affects athletes, particularly runners and cyclists. In this comprehensive guide, we’ll explore what ITBS is, its symptoms, causes, diagnosis and self-management strategies.
What Is Iliotibial Band Syndrome?
The Iliotibial Band (IT band) is a thick tendon that runs from the hip to the knee. ITBS occurs when this band becomes irritated due to friction against a bony anatomical landmark around the knee joint and/or fatty tissue on the outside of the knee . The pain typically occurs on the outside of the knee during activities like running or cycling.
Symptoms
Common symptoms of ITBS include:
1. Lateral Knee Pain: Sharp or aching pain on the outer aspect of the knee with running, walking occasionally at rest when severely irritated.
2. Thigh or Calf Discomfort: Pain may radiate into the outer thigh or calf.
3. Aggravation with Movement: Pain worsens during running, especially downhill.
What Causes ITB?
Muscle Weaknesses
The quadriceps group consists of four muscles: rectus femoris, vastus lateralis, vastus medialis, and vastus intermedius. These muscles are responsible for absorbing shock and stabilising the knee at the point of contact during the running gait cycle.
The lateral hip: consisting of gluteus medius and gluteus minimus which allow the lower limb to stabilise during stance phase of the running gait cycle.
Training Load Errors and Poor Running Mechanics
1. Over-Striding:
Over-striding occurs when your foot lands too far ahead of your centre of mass during running.
Why is this important? It reduces the knee muscles’ ability to absorb shock, causing energy loss into the ground instead of propelling you forward.
2. Crossover Gait:
Crossover gait patterns occur where the foot crosses the midline of the body, can lead to iliotibial band syndrome (ITBS) by increasing lateral knee stress and friction on the IT band.
3. Training Load Errors:
Sudden Increases: Rapidly increasing mileage or intensity without adequate time for adaptation.
Inadequate Recovery: Insufficient rest between runs hinders tissue repair and increases the risk of ITBS.
Terrain: Changes in training environment such as increasing downhill running or running on uneven/cambered surfaces can lead to increased forces at the ITB.
How can you determine if you have ITBS?
While consulting a healthcare professional is essential, you can perform some self-diagnosis steps:
Pain Location: Identify if the pain is primarily around the outside of the knee either slightly above the joint line or slightly below the joint line where the ITB nears its attachment on the tibia.
Pain with movement: You may experience pain with a decline single leg squats depending on the severity of your symptoms.This movement forces the ITB to be subjected to excessive strain as you lower into the squat.
Self-Management Strategies
Reduce your running load: This refers to both the total running mileage as well as pace during your faster runs. For some of you, faster runs might need to temporarily pause followed by a careful and progressive reintroducing of these sessions.
Strength training: Work on building strength in the muscle groups that surround and move the knee joint (Quadriceps and Hamstrings). As well as your lateral hip (gluteal muscles) that plays a role in stabilising the leg during running. Finally, once your symptoms are resolved, add in appropriate landing control and plyometric exercises to help reprogramme the knee, your nervous system and brain to execute movement accurately. Refer to the video for some examples of movements you can implement.
Running Biomechanics: Increasing cadence has been shown to be extremely effective in addressing over-striding and crossover gait patterns. The increase in cadence needs to be based on your preferred cadence and not on an arbitrary number (e.g. 180). Finally and most importantly, increasing cadence needs to take place under the same pace, so as to avoid over-striding. A great cue to keep in mind is taking shorter steps.
Terrain considerations: Avoid hills and uneven/cambered running routes. It’s best to stay on flat ground as you rehab and get back to full fitness.
Understanding ITBS empowers you to take charge of your injury. However, remember that seeking help from a medical professional is essential for an accurate diagnosis and getting an individualised management plan to address your symptoms and return back to achieving your running goals.
For expert help and management please feel free to contact my team at The Running Room (www.therunningroom.net)