Iliotibial Band (ITB) Syndrome is a common injury, especially among runners, characterised by pain on the outer side of the knee. This article delves into the causes, symptoms, and effective treatments for ITB pain. By understanding its origins and following a structured rehabilitation plan, individuals can effectively manage and overcome this condition.
What is Iliotibial band pain?
Iliotibial band (ITB) pain is the most common source of lateral knee pain in runners. The pain is localised over the lateral femoral condyle which is located on the outside aspect of the knee. Runners with acute ITB pain may describe a sharp quality of pain that builds up with running, and the pain can require cessation of running.
What is the cause of ITB pain?
The ITB is a strong fibrous band of tissue that originates from the outer hip and travels down the outside of the thigh with multiple attachments to the outer aspect of the knee. The ITB has several layers as it attached to femur (thigh bone) along its length. The ITB band plays a role in stabilising the hip and the knee, and storing and releasing energy in a similar way to a tendon.
ITB pain is thought to occur when the ITB is overloaded causing thickening of the ITB around the knee and overly compress a highly innervated layer of fat tissue that lies between the ITB and the bony surface of the femoral condyle, leading to irritation and pain.
Who gets ITB pain?
ITB pain is more likely when training demands exceed the body’s adaptive capacity. Runners who rapidly escalate their training intensity without adequate preparation are particularly at risk. Once injured, even low-impact activities can trigger pain.
- Long-Distance Runners: Due to repetitive strain on the ITB, long-distance runners are particularly susceptible, especially if they suddenly increase their running distance or intensity.
- People with Weak Hip Muscles: Weakness in hip muscles, particularly the gluteus medius, can potentially play a role in development of ITB pain.
- Individuals with Poor Running Mechanics: Overpronation (rolling inward of the foot) or other biomechanical issues in running are possible risk factors.
- People with a Previous Knee Injury: Previous injuries can lead to compensatory movements that put extra stress on the IT band.
- Individuals Who Perform Repetitive Activities: Jobs or activities that require repetitive bending and squatting can lead to ITB issues.
- People with a Sudden Increase in Activity Level: Those who rapidly increase the intensity or duration of their workouts without proper conditioning are at risk.
- Age Factor: Middle-aged people who engage in sports are more prone to ITB syndrome compared to younger athletes, likely due to decreased flexibility and muscle strength.
Understanding the Injury Cycle
Runners will often temporarily cease running when ITB pain occurs, causing the irritability to decrease. This results in the runner avoiding loading the ITB and the runner can unknowingly lose even more load capacity (the capability to handle particular training loads or activities). The runner can be deceived into thinking that the injury is better and rush the process of returning to their normal running volumes, and essentially repeat the same error of increasing the training load too rapidly.
This unhelpful cycle is nicely depicted by this figure created by Dr Rich Willy.
Rehabilitating the runner with ITB pain
Before commencing a rehabilitation program, it is important to have your pain examined by a health professional such as a physiotherapist to rule out other potential causes of pain including bone stress injuries, meniscal injuries, and patellofemoral pain.
A physiotherapist can also help you look at your training history to ensure that good training practices are being observed.
Once the diagnosis of ITB pain has been made, the rehabilitation can be divided into four main phases.
Phase 1 – Objective: Reduce activities that aggravate pain.
The goal of phase 1 is to modify or reduce painful activities to allow the irritation and pain to settle. In some cases when the irritability is high this may require a short rest period from running. However, there are cross-training options to maintain your cardiovascular fitness and limit loss of tissue capacity.
- Altering Running/Training Routines: Modify intensity, duration, and frequency of runs or workouts.
- Taking a Break: Briefly pause running to alleviate immediate stress on the IT band.
- Cross-Training: Engage in low-impact exercises like swimming or cycling to maintain cardiovascular fitness and prevent loss of overall conditioning.
Phase 2 – Objective: Enhance muscle strength around the hip and knee.
The goal of phase 2 is to build up the strength of the muscles around the hip and knee, and restore the overall tissue capacity. This will include a guided progression of both strengthening and plyometric exercises.
- Strengthening Exercises: Focus on targeted exercises for hips, glutes, and thighs to support the IT band.
- Plyometric Routines: Incorporate controlled plyometric exercises to improve muscular responsiveness and coordination.
- Gradual Intensity Increase: Progressively intensify exercises to build strength without overloading the IT band.
Phase 3 – Objective: Safely reintroduce running.
The goal of phase 3 is to make a successful return to running.There are a variety of strategies to assist you in safely returning to running:
- Run-Walk Intervals: Start with alternating running and walking to gradually reintroduce running stress.
- Treadmill Use: Utilise treadmills for controlled incline and pace, easing the transition back to regular running.
- Adjust Running Mechanics: Temporarily modify running form (e.g increase cadence) may reduce strain on the IT band, possibly under guidance from a physical therapist or coach.
Phase 4 – Objective: Return to full training and competition readiness.
The goal of phase 4 is to: increase running volume further, return to downhill and speed training sessions, and be ready for competition. Phase 4 is essentially an extension of phase 3, where activities that are more challenging for the ITB are reintroduced. Some next steps to consider may be:
- Increase Running Volume: Gradually build up running distance and intensity, monitoring for any signs of recurring pain.
- Reintroduce Challenging Activities: Carefully add back activities that stress the IT band more, such as hill running or speed workouts.
- Preparation for Competition: Tailor training to prepare for specific competitive events, ensuring the IT band can withstand the demands.
- Each phase should be approached with patience and attentiveness to the body’s response. Consulting with a physiotherapist or exercise physiologist can guide this process effectively.
How long with recovery take?
Recovery time frames vary and are difficult to predict. If addressed early some people can see improvements in as little as 2-4 weeks. However, returning to normal training volumes will likely take longer. Consistent rehab and allowing time for recovery is key! It can take 12 weeks or more to see significant improvement.
Importance of Expert Consultation
ITB pain, while common among runners, can be effectively managed with a comprehensive understanding and a structured approach to rehabilitation. By addressing the causes, symptoms, and following a phased recovery plan, individuals can successfully navigate their way back to pain-free running and activity.
It is crucial to consult a healthcare professional to rule out other causes of pain and to receive a tailored rehabilitation plan. Get in touch with our experienced team at Coast Sport and start your journey toward a more mobile and comfortable future.
References:
Willy, R. (no date) Iliotibial Band Pain: practical strategies for treating runners, Physio Network. Available at: https://www.physio-network.com/masterclass/iliotibial-band-pain-practical-strategies-for-treating-runners/ (Accessed: 18 July 2023).
Goon, T. (no date) 2023 Running Repairs Online, Clinical Edge. Available at: https://www.clinicaledge.co/member/training-programs/running (Accessed: 18 July 2023).
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