Iliotibial band syndrome (ITBS) is one of the most common injuries in endurance runners. It’s usually felt as a pain in the side of the knee, where the tight band of connective tissue known as the ITB connects the knee.
The ITB is a band of strong connective tissues (similar to a tendon) that attaches to the tensor fascia late and gluteus maximus muscles. It also attaches to the femur along it’s length, inserting into outside of the knee.
Historically it was thought the ITB’s only role was to stabilise the knee and hip. Research now suspects that the ITB may behave like a tendon, in that it stores and releases energy when running.
Below we will outline 5 steps to managing your ITBS and running pain free!
1. Manage running load
Iliiotibial band syndrome (ITBS) is an overuse injury (Like 99% of running injuries). The first step of managing overuse injuries is managing your current running load, to give the tissues some time to adapt. It is very common to experience ITBS when you suddenly increase your running load over a short period.
3 ways to manage running load:
- Reduce your overall running volume: As ITB injuries are usually due to overload, we need to reduce load from running to avoid further aggravating the injury. Use pain as a guide for reducing running volume. Try to keep your ITB pain below 4 out of 10 on a 0-10 pain scale when running. If your pain is over this level, or the pain is worse 24 hours after the run, you may need to reduce your running load further.
- Avoid very slow running: Studies suggest that slow running increases load on the ITB and is more likely to irritate it (Fredericson et al. 2005). Begin with repeated short, easy sprints. Reintroduce slower paced longer runs gradually.
- Avoid downhill running: Studies also suggest that downhill running increases loads on the ITB, due to increased knee flexion (Fredericson et al. 2005). Avoid excess downhill running in the initial stages of injury. Slowly re-introduce downhill running at the later stages, using pain as a guide.
2. Strength Training
Although the exact causes of ITBS are unknown, we do know some contributing factors that we can manage. Weakness in the muscles around the side and back of your hip (gluteus medius and maximus, hip external rotators and adductors) are associated with ITBS.
Including strength exercises for these muscles is essential to improving ITBS pain and reducing the likelihood of the injury returning in the future.
Exercises to include are:
- Step ups (Progress by adding weight or increasing height of step)
- Single leg deadlifts (Start with light dumbbell and slowly progress)
- Static wall squats (hold weights weights on shoulders to progress difficulty)
Remember that treatments such as foam rolling, dry needling and massage are for helping reduce pain in the short term. Alone, they do not provide a long term solution for treating ITBS or preventing it from recurring.