Runners will often develop Iliotibial Band Syndrome (ITBS) after running on uneven terrain or downhill.
The pain, located on the lateral (outside) leg or knee, can be very debilitating to the point that running or hiking activities have to be stopped.
Even walking becomes difficult. If you handle your pain and symptoms quickly, ITBS can be easily self-treated.
This post will help you discover the risk factors for ITBS, and learn how to quickly return to your running routine with these self-treatment techniques.
9 Tips to Self-Treat ITBS
Iliotibial Band Syndrome (ITBS) is also known as IT Band Syndrome, ITB Syndrome, and IT Band Friction Syndrome. Pain can range from the outside (lateral side) of the leg up toward the hip area to just below the outside (lateral) of the knee joint. There may or may not be notable swelling.
The condition is usually associated with an inflammatory process along the side of the knee. To confirm if you’re experiencing ITBS, first bend your knee to a 45 degree angle. Then feel for tenderness along the outside edge of the knee, where the IT Band is located toward the side of the upper leg.
ITBS is often defined as an over use injury. For runners, a common cause is running downhill. Few runners actually train appropriately for a race with downhill running. Afterward, they end up with a case of ITBS.
I have been guilty of improper training in the past and developed this condition after a 10k trail race. To avoid ITBS, adequately train for the downhill portion of the race. Also, vary your running routine and surfaces while training. Although ITBS is often associated with over use, always address other contributing factors as well.
Risk Factors for IT Band Syndrome:
- Poor hip or pelvic mobility.
- Fascial restrictions and tightness in the lower leg or pelvic muscle.
- Bowlegged, a medical condition known as a varus deformity. It is caused by an inward rotation of the tibia (lower leg bone) resulting in a leg that looks like it is bowed out.
- Total knee or hip replacement.
- Weakness in the hip external rotators and the hip abductors, such as the Gluteus medius and the Tensor fasciae latae (TFL). These muscles are located on the side of the hip or deep in the buttocks.
- Improper training or not being prepared for the terrain.
- Improper footwear.
- Gait or running abnormalities, such as over striding or scissoring (when your leg crosses over the midline with each step).
9 Tips to for Self-Treatment:
1. Improve your mobility.
Poor lower leg or pelvic mobility as well as myofascial restrictions are highly correlated with ITBS. The tighter the IT Band, the more likely it will rub and develop into pain.
I recommend using a foam roller or a Thera-Band Roller Massager to address tightness in the quadriceps and IT Band. You may also utilize a tennis or lacrosse ball to appropriately mobilize the Tensor fasciae latae muscle (TFL). Stretching the IT band or the TFL is very difficult, so I tend to utilize other mobilization techniques. However, I recommend a few pelvic and hip stretches.
Please refer to IT Band Rehabilitation Exercises.pdf for my top exercises, stretches, foam rolling, and self-mobilization techniques to address IT Band related issues.
2. Strengthen your hip muscles.
Weakness in the hip external rotators and the hip abductors, like the Gluteus medius and the Tensor fasciae latae (TFL), can lead to IT Band Syndrome. Strengthening of these muscle groups can help in avoiding future ITB issues.
3. Train for the terrain.
As you prepare for upcoming spring and early summer races, be sure to train for the terrain. If the course is hilly or has a longer downhill portion, dedicate some of your training runs to simulate the race course. ITBS often occurs due to inadequate training for the expected course terrain.
4. Check your shoes.
Your shoes may be worn out and may be the cause of the pain. Remember that the inner cushion and structure of the shoe can wear out before its outer appearance. If this occurs, the shoe can no longer adequately control inappropriate foot and heel movements. This could result in IT Band Syndrome or other hip, knee, or ankle related issues. Shoes typically only last 350-500 miles.
If you are nearing those miles, then it may be time to change. If you’re unsure if your shoes are performing correctly, visit your local running shoe store. The trained staff can inspect your shoes for wear and tear. They may ask you to walk or run in order to watch your gait to fit you in the appropriate shoe. Another option to help control foot mechanics is an over the counter orthotic such as Superfeet Blue Premium Insoles.
In my experience, these insoles can last 1,000 to 1,500 miles easily. If the over the counter options aren’t helping, you may be a candidate for custom orthotics. Please seek assistance from a physical therapist or podiatrist.
5. Have your gait analyzed while running.
Gait or running abnormalities can increase your risk of developing IT Band Syndrome. Over striding tends to occur while running downhill. Scissoring occurs when your leg crosses over the midline with each step. Both over striding and scissoring are easily recognized by a professional.
Check with your local running store or a physical therapy clinic for a monthly gait analysis clinic. If you’re unable to obtain a gait analysis, ask your spouse or a friend to video record you (from behind) while you’re running. Then watch the recording to see if you notice either over striding or scissoring. If you identify either of these two running abnormalities, you will need to adjust your gait in order to prevent ITBS or other running related injuries.
6. Initially take time to rest and recover.
I typically advise a week or two of rest to focus on the mobility and strengthening portion of your recovery. This also allows enough time for your body to complete the acute stage in the inflammatory cycle.
7. Don’t forget to ice.
IT Band Syndrome is typically is due to a specific event. Afterward, there is usually an active inflammatory process occurring. Apply ice to the side of the knee, the outside of the thigh, and on your most painful area. The rule for icing is to apply ice no more than twenty minutes per hour. Don’t place the ice directly against the skin, especially if you are using a gel pack style. Individuals with poor circulation or impaired sensation should take particular care when icing. A bag of frozen peas can be a cheap alternative.
8. Warm up prior to exercise.
Once you are ready to return to running, I recommend that you increase your normal warm up time by at least 10 minutes in order to increase blood flow to the area. This allows for better mobility and also promotes healing as movement is necessary to bring in the nutrients. Once the area is warm, then progress into specific running drills such as walking lunges or butt kickers. Using a foam roller over the lateral leg is also an excellent method to prepare the area for running. Unlike static stretching, foam rolling doesn’t impede performance.
9. Cool down.
After performing your exercises, take extra time to cool down. Spend extra time stretching. I also advise using the foam roller as part of your cool down protocol. Don’t sit for any length of time after your run. Stay active!
Prior to returning to your normal training activities, insure the following:
- Your involved leg is as flexible as the other.
- Discomfort while foam rolling or with mobilization on the affected side is similar to the opposite leg.
- Your involved leg is as strong as the other leg.
- You can jog, run, sprint, and jump without pain.
With proper treatment, this condition should resolve in 2-3 weeks. Severe cases will take longer. As you taper back into your running program, follow these guidelines:
- Although you will need to progress and train for downhill running, initially start with level terrain only.
- Initially limit your running distance. I recommend starting with a distance approximately 50-75% of your pre-injury distance.
- Initially start with a slower pace. Don’t immediately progress back into very intense running activities, such as interval or downhill training, until you have worked back up to your previous running distances and paces without pain. This process may take 4-6 weeks depending on the severity of the case.
- Continue with the rehabilitation protocol until you are performing all of the exercises and running normally without pain. Utilize the prevention strategies outlined above in order to avoid future reoccurrences.
If you handle your pain and symptoms quickly, ITBS can be easily self-treated. If you’re not experiencing relief after two to three weeks of aggressively managing the symptoms, contact your local physical therapist for an assessment and help in managing IT Band Syndrome.
The American Physical Therapy Association offers a wonderful resource to help find a physical therapist in your area. Early management is important for a timely recovery. For additional information on common running injuries and how to self-treat, please visit www.thePhysicalTherapyAdvisor.com.