Many of us turned to running as our primary source of physical activity when COVID-19 forced us to close gyms, yoga studios and other public and group-based exercise facilities. This gave many the opportunity to experience the unique thrills of running such as:
- completing our first 5 km run
- beating a personal best time
- achieving the elusive “runner’s high”
Some of us who rapidly increased our training loads may have experienced outer knee pain after time. Many of these people may have experienced iliotibial band syndrome (ITBS).
ITBS is characterized as sharp pain on the outer aspect of the knee that occurs with movements where the knee is slightly bent, such as going down stairs. It usually presents after a large increase in training volume in a short period of time. ITBS is a poorly understood injury which can leave clinicians and patients frustrated. I would like to share with you 5 things you should know about ITBS and how you can prevent it in the 2021 running season.
1. What is the Iliotibial Band, and what does it do?
The iliotibial band (IT band) (FIGURE 1) is a thick piece of fascia which runs from the outer aspect of the hip to just below the outside of the knee. Fascia is a tissue found all over the body which functions to transmit forces produced by our muscles throughout the rest of the body. To learn more about the role of fascia, take a look at an article written by my colleague, Igal Untershats, on functional fascial techniques.
(FIGURE 1: The IT Band)
You can find the IT band by feeling the outside of your pelvis and running your fingers directly down the outer part of your thigh until you get to your knee. The IT band functions in a few ways:
- Stabilizes the outer knee,
- Acts as an attachment for muscles in the lower body
- Functions like a spring to store and release energy during walking and running.
2. What happens to the IT band when ITBS occurs?
Near the bottom of the outer thigh, the IT band runs over a projection of the femur (thigh bone) called the lateral epicondyle (FIGURE 2). This part of the IT band is highly innervated and is also subjected to very high levels of compression force when the knee bends to 30 degrees (FIGURE 3). In running, cycling and hiking, we are continually moving through this position. During every step we take when running and every pedal we make during cycling we are moving through this high compression zone. If the relative amount of compression increases at a rapid pace, like it does with an increase in training volume, the highly innervated part of the IT band can become irritated and lead to pain.
(FIGURE 2: Lateral Epicondyle of the femur)
(FIGURE 3: The right knee is bent to 30 degrees flexion. In this position, the IT Band is under high loads near the knee)
3. Who is more likely to get ITBS?
Those of us who quickly increase our volume of exercise that involves the knee moving into 30 degrees of knee bending, such as running, cycling and hiking are more likely to experience ITBS. Research has also shown that male runners are more likely to experience the condition than female runners1.
In the case of runners, technique matters! If you run with your hips in an adducted position (closer to midline) you are more likely to experience ITBS as this places more strain on the IT band (FIGURE 4). This adducted position naturally occurs during downhill running as well as in runners who tend to run with a narrower running pattern.
(FIGURE 4: In picture “B” the hips are more adducted towards midline which places greater strain on the IT Band on the outside of the thigh)
4. What can be done to reduce ITBS pain?
There are a few things which can be done to alleviate ITBS pain:
- Training modifications: You will most likely need to reduce your current training volumes and may even need to temporarily replace running with walking or uphill treadmill walking, both of which reduce movement into the problematic 30-degree knee bent position. Once pain has settled, you can gradually return to your previous training volumes. Be careful to slowly and progressively increase these volumes or it may lead to more irritation of the IT band.
- Hip Abductor strengthening: The hip abductors are a group of muscles which are very important for stabilizing the pelvis in a single leg stance position (FIGURE 5). As running is primarily a single leg exercise, improving the capacity of these muscles is of utmost importance! Additionally, the hip abductors function to prevent excessive adduction during running, so strengthening and improving control of these muscles can prevent cumulative strain on the IT band.
- Gait pattern modifications: Running patterns come in many variations and as illustrated previously, particular patterns make runners more prone to injury. Altering your running pattern to a wider stance can be helpful for ITBS pain. Additionally, increasing cadence, or the frequency of steps per minute, can be helpful. Take a look at this video to understand why!
(FIGURE 5: The Gluteus Medius muscle functions to stabilize the hip and to prevent excessive adduction in a single leg stance position)
5. When should I see a therapist for ITBS?
If you are experiencing pain with running, seeing a physiotherapist or rehab specialist can help determine if ITBS is involved. The diagnosis is key to your recovery.
A skilled therapist, with experience working with runners, can help guide you through training modifications, strengthening exercises, running pattern changes and more.
If you have knee pain and are unsure if it is ITBS or want to develop a training program to prevent this injury, please contact the Orthopaedic Therapy Clinic at (416) 925-4687 and schedule an assessment with Taylor Sipos, Registered Physiotherapist. You can also email Taylor directly at firstname.lastname@example.org.
- Charles, D., & Rodgers, C. (2020). A LITERATURE REVIEW AND CLINICAL COMMENTARY ON THE DEVELOPMENT OF ILIOTIBIAL BAND SYNDROME IN RUNNERS. International journal of sports physical therapy, 15(3), 460.
FIGURE 1: https://www.selectchirowellness.com/blog/2018/1/10/it-band-syndrome
FIGURE 2: https://stuart-hinds.com/blogs/performance-therapy/recognising-and-treating-iliotibial-band-syndrome
FIGURE 4: https://www.physio-network.com/blog/iliotibial-band-pain-in-the-runner-part-1-etiology-and-assessment/
FIGURE 5: https://www.amitypt.com/2018/09/24/medius-and-minimus-the-unsung-glutes/