Running Tips – Treating ITB Syndrome

ITB Syndrome is a common injury for runners. It can happen gradually, starting with a twinge on the outside of your knee and a tightness in your hips, or you might not notice until it’s manifesting as a sharp, intense pain on the side of your knee and thigh, making it impossible to run. The good news is, it’s treatable and preventable. The bad news is, you won’t be able to run while you’re suffering from ITB Syndrome.

This installment of the Running Tips series explains what causes ITB Syndrome, how you can effectively treat it, and how you can prevent it from happening again. Read on, so you can get back to running sooner!

What is ITB Syndrome?

The iliotibial band is a thick band of ligament and fascia, which runs all the way down the outside of your hip. It originates on the pelvis and inserts on the tibia bone in your lower leg. ITB Syndrome occurs either when the ITB rubs against the lateral epicondyle of the femur (in layman’s terms, the knobby bit at the end of the femur, on the outside of the leg), or when tension from muscles attached to the ITB in the hip (gluteus maximus and tensor fascia latae) cause inflammation in the band.

Either way, you end up with an inflamed band, which causes pain on the outside of your knee. You may even hear, or feel, a popping, or snapping as the band rubs over the epicondyle. An early warning sign of ITB Syndrome can be a tightness in your hips as you run.

The causes of ITB Syndrome 

Basically, anything that causes prolonged internal rotation of the hip can contribute to ITB Syndrome. This includes consistently running on a banked surface, so one leg is always higher than the other when running; consistently running only in one direction on a track; downhill running; wearing worn-out shoes; and through overuse – either high mileage, or increasing mileage too quickly.

Treatment options for ITB Syndrome

Okay, here’s where you get the bad news. The number one treatment for ITB Syndrome is to stop running. I know, it sucks. You can still cross train while you’re healing, but avoid stair climbing, since that will exacerbate the problem. Pool running, walking, elliptical, rowing and swimming should all be fine. You can try cycling, but bear in mind ITB Syndrome also occurs in cyclists, particularly if their feet point inwards as they pedal, so if it hurts, don’t do it! (Likewise, if you swim, breaststroke could be either harmful or beneficial, since you’re working both the abductors and the adductors. Again, if you try it and it hurts, just stop).

The best idea is to see a doctor, preferably a sports orthopedist, in order to get the diagnosis and specific instructions on treatment. If your doctor is unsure if it is ITB Syndrome causing your pain, he or she will most likely send you for an MRI – a regular x-ray won’t reveal the issue, but an MRI can show a thickening in the band, where it’s inflamed.

The reason I suggest seeing your doctor first is because often one of the prescribed treatments is to take NSAIDs, but these aren’t appropriate for everyone and your doctor should be the one to tell you exactly what daily dosage to take. So don’t go popping handfuls of Advil until you check with your doctor!

Apart from the two basics (stop running and visit the doctor), here are some practical ways to lessen the pain and treat the injury:

• Massage. If you can afford to go to a massage therapist, don’t hesitate. You preferably want a sports masseuse, or someone used to working on runners and other athletes. You can get recommendations from your doctor, from a personal trainer, or from your local running club.
• Foam rolling. You can do this instead of, or in addition to getting massage therapy. Buy your own and keep it at home – you won’t regret it. Don’t focus just on rolling the ITB, though – you really want to roll out your calves and your adductors (the muscles of your inner thigh). These are the muscles doing lots of work which can contribute to the injury, so you want to loosen them up as well.
• Sleep with a pillow between your legs, if you’re a side sleeper, to reduced tension on the band.
• Ice the painful area to reduce inflammation.
• Strength training. You want to focus on strengthening the gluteus medius (the muscle on the outside of your hip), the gluteus maximus (your butt) and the tibialis posterior (a small muscle which runs the length of the back of your calf). Great specific exercises for these muscles include:
  • Bridges. Lying on your back with knees bent, raise your hips as high as you can, then lower. Squeeze your butt as you raise.
  • Lateral leg lifts. Lying on your side on the floor, raise your top leg away from your body. Try not to point your foot. You should feel this on the outside of your hip.
  • Calf raises. When you do calf raises, make sure your foot is not rolling outwards as you do. You want your weight equally distributed over the ball of your foot.
  • Clams. Lie on your side on the floor, with hips and shoulders in line and  knees bent at 90 degrees to your body. With your toes glued together, raise the top knee away from the bottom knee, then return to start. (It will look like a clamshell opening and closing).
  • Squats and deadlifts, lateral lunges, using cables for leg extension, or lateral leg raises, can also be included in your general strength training.

And what about stretching? Well, the ITB isn’t a muscle – it’s fascia, so it doesn’t respond easily to stretching. Again, check with a doctor (preferably a sports orthopedist), or a physical therapist, to get specific stretches for the ITB, rather than just googling. However, in my opinion, stretching is probably the least effective means of treatment.

Prevention is the best medicine

Scroll back up the the causes of ITB Syndrome section. Don’t do any of those things! That’s the best advice for prevention.

• If you are unable to run on a flat surface, then counteract the cumulative effect of running on a banked surface by alternating the direction in which you run, whether that be every mile, or every loop – whatever works for your running area.
• Most tracks alternate directions on different days – if this is the case with your local track, then you may need to do your track workout on a different day every other week.
• Make sure your running shoes are not worn out (especially if they tend to wear on the outside of the sole first) – a general rule of thumb is to replace them every 300 to 500 miles.
• A regular strength training program, including the exercises listed above, will help with prevention of future occurrences of this injury.
• Make foam rolling a regular routine. You can purchase a foam roller in most sports stores, or online. They start at about $15 for a basic roller, which is what I use regularly, but you can buy special trigger point rollers which are more expensive.
• Finally, keep a training log to ensure you’re progressing your mileage appropriately. It would definitely be worth consulting a specialized running coach for your return to running after recuperating from ITB Syndrome, since you’ll essentially be starting from scratch (no running, remember? 😉 )

I experienced ITB Syndrome when training for the NYC Marathon in 2010. It was painful and an emotional experience to have to stop running when I was in peak cardiovascular condition from the training I was doing. I saw a doctor after I had to stop not even halfway through a planned long run and incorporated much of the above advice for treatment. To this day, I still follow all the advice I’ve given you for prevention, since I plan on never having to go through ITB Syndrome again!!

Have you suffered ITB Syndrome? What did you do to treat the problem? What do you do to prevent it recurring?