Are you a runner or cyclist that gets a pain at the outside of the just above the knee ? Are you foam rolling religiously with no long term benefits ?
If this sound like you read on as this is for you as it will provide the answer to the problems of the ITB.
What is the Iliotibial band or the ITB as it’s more commonly known ?
ITB syndrome is a common injury in sports or activities that require a repetitive bending and straightening of the knee, especially around a 30 degree knee range of motion. Hence why runners and cyclists are prone to this issue.
What is the ITB and what does it do ?
The ITB is a thick fibrous band of fascia that originates from the fascial components of major hip muscles at the side of your pelvis , these being the gluteus maximus , medius and the tensor fascia lata.
It travels down the outer side thigh blending with the outer quadriceps muscles and attaches into outside aspect of the kneecap and Gerdy’s tubercle on the outside of the tibia.
It is a very strong structure and is similar in structure to a form of tendon tissue but with smaller amounts of elastin making it incredibly difficult to stretch.
What does the ITB do ?
The ITB’s main two functions are:
- Stabilize the knee when standing or in the stance phase of walking / running without the body relying on the quadriceps working continuously. This would be very taxing on the quads from an energy perspective.
- The other role is it acts like an elastic spring especially in running and walking. As the knee is flexed and moves forwards it creates tension and stores energy in the ITB. Then when the leg swings back this releases the stored energy assisting with forward movement. Again this is a very energy efficient way to move.
Why does the ITB cause pain ?
As the knee is repetitively flexed and extended when we run or cycle this creates friction and compression at the side of the knee.
The source of the pain is suspected to be from:
- highly innervated fat pad that lies between the femoral condyle and the ITB.
- Bursa that lies under the ITB
- ITB itself
These structures become inflammed and painful with the repetitive friction and compression of the ITB..
The main issue is that regardless of which tissue is the sensitive one its the repetitive compression or friction by the ITB at this point that is to blame.
Why doesn’t the foam roller or massage fix ITB for the long term?
Foam rolling and massage may give symptomatic relief but in most cases the problem either persists or becomes a recurrent problem. This is because you are using a compressive or friction based treatment which is the same mechanism that causes the problem.
What causes ITB syndrome ?
Muscle strength and ITB Syndrome
Weakness in the hip and lower leg muscles often contribute to ITB syndrome. Weakness of these muscles in turn affects movement control at the lower leg and directly affects the following 2 issues
ITB and shock absorption
Remember how we said the ITB was to function like a spring a lack of strength in the hip muscles can result in the spring like quality of the ITB deteriorating. It may also be related to too much volume with training and even a lack of jump specific training such as skipping or plyometric type activities.
Running style and ITB syndrome
The following traits in running have been associated with ITB syndrome in runners:
These can often be improved with adjustments to training , running style and hip strength
- Increased knee internal rotation during stance.
- Increased hip adduction – is there a knee window?
- Increased contralateral pelvic drop.
- Narrow stride width – increases ITB strain, strain rate and hip adduction
- Over-striding
Tissue flexibility and ITB syndrome.
There is some debate as to whether you can actually stretch the ITB ad if it actually has any long term permanent changes. However maximising hip mobility and the flexibility of hip flexors , rotators and the hamstrings can be beneficial in treatment of this condition.
Training load or methods and ITB syndrome.
Undoubtedly a common issue we hear at the clinic is one of people making sudden jumps in their volume of training or not taking enough rest. Its the scenario of going from zero to hero in as short a time as possible.
Also sudden changes in surface that they are running or cycling on can influence these symptoms. A change from flat to more hilly or uneven surfaces can overload the ITB and cause increased friction. The flip side to the coin is runners who run the same course on the same camber may overload the leg that spends most time on the downslope.
The solution to this issue is gradual exposure to more challenging terrain and also altering the course you do so you don’t overload one side more than the other.
Body shape and ITB syndrome.
Have you ever seen a sprint cyclists thighs ! impressive quads.
Individuals that have large lateral quadricep bulk will naturally increase the tension of the ITB and the compressive effect it then has against the femur. As such cyclists and the “sturdier ” built runner is probably more at risk. As this is not something we have control over its more relevant to focus on the above issues to resolve the problem.
What is the best way to sort ITB syndrome ?
The most important aspect is to identify factors that are contributing to the problem. These usually are a combination of the above issues and most likely will require a good strengthening program for most people followed by subtle changes to running style or training load for the runners.
Exercises for ITB syndrome.
Here’s a simple bodyweight exercise program to use if you suffer ITB issues based on the most common issues that are easy to address.
Here is more information and videos for hip strengthening exercises… strong glutes
If you are struggling with ITB syndrome get in touch with us or book an appointment with one of the team here
Alternatively if you’d like to get a running specific strength program check out this program we run
Cheers
Dave
