Iliotibial Band Syndrome

When life hands you a lemon, make lemonade! When life hands you Iliotibial Band Syndrome ("ITBS"), crosstrain and rest! I'm currently facing a little ITBS, which sounds like it might be a really cool acronym for something (like "TGIF"), but it's actually not very fun at all! According to http://www.youcanbefit.com/itbs.html and many other websites, ITBS is a common cause of knee pain in runners, bicyclists, martial artists and dancers. It is characterized by sharp or burning pain on the outside (lateral) side of the knee, thigh or buttocks.

I made the initial mistake of running through the pain for over a week, but I've come to the conclusion that stubbornness is not going to eliminate the problem. I attempted a seven mile run from Owen's house over the weekend, but the pain on the outside of my right knee forced me to walk at mile two. My knee was free from pain at the start of the run, but it came on shortly after the first mile into my run. I experienced similar pain midway through my treadmill run last Tuesday as well.

I first encountered ITBS at the end of my recent 13.5 mile run. I definitely "over did it" that day, and I'm simply facing the consequences. I also attribute my injury to both my new and old running sneakers. I had been in desperate need of a new pair of shoes, but I was unable to find good fitting shoes in my size. I settled on sneakers that were simply too big, but I flip flopped around in them for a few weeks nonetheless. After conducting a city-wide search for sneakers, I was able to find the exact replica of my favorite running shoe (Asics GT-2100) in a small, size five at the Boston Running Company on Sunday! I'm convinced that my new running sneakers will work miracles!

I'm also on the R.I.C.E program, which stands for rest, ice, compression, and elevation. I've been doing the ITB stretches that I found online, and I'm going to take a few days off from running. My goal is to reduce the inflammation. I'll continue to use the elliptical machine and the arc trainer as long as there's no pain, so that I am able to stay in tip-top shape for the marathon! I've consulted "Dr. Mo" and "Coach O" for their advice, and both gave me good information. I've also spent a lot of time researching ITBS, and I've copied and pasted some additional information below from the above website.

What is the ITB and what does it do?
The ITB is a wide, flat ligament like structure that runs down the side of the thigh from the side of the hip (iliac crest) to the lateral part of the bone just below the knee (tibia). It provides stability to the outside of the knee and helps control inward motion of the thigh. The ITB is not attached to bone as it passes between the femur and the tibia. This allows the ITB to move forward and backward with knee flexion and extension.

The function of the ITB is to slow down or decelerate adduction (movement toward the midline of the body) of the thigh during walking or running. In other words, the ITB stabilizes the thigh and prevents unnecessary side-to-side motion. "This adduction occurs about 90 times per minute per leg as you run and almost 22,000 times during a four-hour marathon! No wonder the ITB sometimes complains!" (1)

What causes ITBS?
ITBS is believed to result from recurrent friction of the iliotibial band (ITB) over the bony prominence just above the lateral portion of the knee. With ITBS, the bursa often become inflamed, causing a clicking sensation as the knee flexes and extends. Over time, inflammation actually diminishes and scar tissue (adhesions) develops from the repetitive tearing of the fibers of the ITB. Because of the build-up of adhesions, the ITB becomes congested and tight with greatly decreased blood flow. This causes a further build-up of congestion and the process continues.

General causes
1. Leg length differences
2. Foot structure: excessive pronation (flat feet)
3. Excessive shoe breakdown (particularly it the outside of the heel) and poor shoe fit.
4. Training intensity errors - increasing mileage or intensity too fast
5. Muscle imbalances - quads versus hamstrings, hip abductor weakness
6. Run/gait style factors - e.g. bow-leggedness, knock knees, etc

Running (2)
1. Running on slanted surfaces (runners who run with the traffic tend to have ITB troubles in their right thigh because that leg must travel a greater distance each time it hits the ground) or run track (the counterclockwise running causes ITBS in the left thigh because the ITB must control a greater deceleration of adduction in the left hip.
2. Too much downhill running.

How to tell if you have ITBS
The key aspect of ITBS is lateral knee pain. Runners often note that they start out running pain free but develop symptoms after a reproducible time or distance. Early on, symptoms subside shortly after a run, but return with the next run. If ITBS progresses, pain can persist even during walking, particularly when the patient walks up and down stairs. "

Treatment
Initially, any inflammation of the ITB must be arrested. This can be done with over-the-counter (OTC) anti-infammatories, but I certainly prefer more natural remedies like bromelain and arnica (see my article Nutrients for Healing for more suggestions). Ice also is important; ice the ITB at least twice per day for 15 minutes. Once the inflammation is addressed the cause of the ITBS must be corrected. Primary muscles used in any activity repetitively require specific attention. If not, they will slowly tighten due to an accumulation of unwanted toxins and a reduction of normal blood flow (nutrition and oxygen) to the muscle. This is why techniques like Active Release and Graston are so effective with ITBS. Both these techniques remove the scar tissue restoring the proper blood flow and oxygenation to the tissue. None of the OTC anti-inflammatories do this! If the scar tissue is not removed the problem will never really be corrected. Areas to be treated must include not only the ITB, but the TFL, gluteus minimus, piriformis, vastus lateralis, biceps femoris, soleus and plantar surface of the foot.

Cutting back on the intensity and volume of training is critical. STOPPING for a bit (1-2 weeks) while getting treatment may be necessary. Do NOT train through the pain! A proper warm-up and cool down is necessary. Warming up and cooling down with the Stick is wonderful. Stretching is part of these. Gentle stretching is critical when recovering- do not overstretch! A gentle pulling should be felt when stretching. There are many ways to stretch the ITB - see the Wharton's Stretch Book and Facilitated Stretching for suggestions. Other muscles which must be stretched included the calf (gastrocnemius and soleus), hamstrings, quadriceps, hip flexors and gluteal muscles.