Managing ITBS – (Iliotibial Band Syndrome)

Iliotibial-Band-Syndrome-1Iliotibial Band Syndrome (ITBS) –  pain on the outside of your knee –  is a fairly common and debilitating running injury with various different causes.  The top two reasons someone develops ITBS is by increasing you mileage too fast, and improper running form.  Putting these two things together is a recipe for disaster.  Coupling those two things by not taking time off makes this injury far worse than it should be if you stop running right when you feel pain.

Improper Running Form: There is a lot to this.  Good distance running form should drive from the hips, mid foot strike, have high cadence (roughly 180 steps per minute), slight forward lean, no cross body arm swinging, and proper foot pronation so that your knee doesn’t cave in, which is most visible from behind, if your foot swings excessively inward or outward.  This may seem like an exhaustive list, but it is meant to show that there are a lot of different ways improper form and contribute to not only knee pain, but hip pain, foot pain, etc, and there are different reasons why each of these things occur.

So lets take a step back and look at some of these more closely.  One of the more common thing you will hear about is to watch out for a ‘forward foot fall’ and to have a midsole strike.  A good analysis on this argues: “The emphasis on foot strike missed the mark by putting the attention on the end of the chain, rather than the beginning. We need to shift our focus upward to our hips and glutes, where the stride begins.”  (First article linked below) If your feet are landing out in front of you for a heel strike, basically pushes the shock into your hips to absorb rather than a bent knee directly underneath your weight with a lot more cushion for the impact. Anterior pelvic tilt which is another common culprit to cause the knees to cave inwards during footfall, and then kick out at the end.  Anterior pelvic tilt is a postural issue that is ingrained day in and day out with how we stand, walk and sit.  This is often caused by, and then exacerbates the issue of weak glutes that are not keeping the knee aligned, so the IT band is then forced to keep the knee moving straight which is too much strain on a much weaker muscle.  Shoes can exacerbate your poor running form by being too cushy because it allows you to land on your heel, which normally would hurt.

It’s All in the Hips: Foot strike, the darling of minimalism, is overrated. Good form starts with the pelvis and the glutes.“The foot is really just the end of a big kinetic whip–the leg. Core and hips are where every runner should be starting if they are really concerned with optimizing their form, maximizing their speed and minimizing injury potential.”

What Does Good Running Form Feel Like?
The power in your stride should come during the drive phase. Too many runners try to extend their stride by reaching forward with their leg during the swing phase; instead, you want to focus on driving your leg straight behind you using your hips.

Here is great video on foot placement while walking and standing.  Rebuilding the feet, part 1 with Brian MacKenzie

Weak and inflexible hips and glutes contribute to ITBS.  Weak and inflexible hips is extremely common due to the typical job of sitting all day.  It is not enough to just strengthen or just to stretch your muscles around your hip.  Both are required to prevent injuries and to get your body to be able to move the way it should.  So when you start to feel pain,  the first immediate solution is to rest, but rehab and prevention is next up, and that entails addressing your mobility and muscle imbalances that led to the problem in the first place.  Your body needs to be in proper alignment, and to also decrease tension in the muscles.  If your muscles are tight and in a constant state of tension, they are working in overdrive, and not functioning properly.  As the glute and hip muscles are the primary movers for driving your leg forward and to keep your knee in proper place while running, if you are out of alignment, or these muscles are weak or are not being activated, your secondary muscles end up being used.  Many articles will point out that the IT band is the consistency of a tire, and can’t be stretched.  That is true to some extent, but the muscles around it can be stretched, and you can also release tension if there are knots through pressure point massage and foam rolling  which serves a different purpose than a stretch.

Solution:  Here are some hip flexor strengthening and glute activation exercises to add to your daily workout:
Clamshells 
Lateral leg raises
Resistance Bands Knee Extension
Glute kickbacks

Some in depth article explaining more about IT Band Pain and common misperceptions:

Iliotibial Band Syndrome: Cause, Cure and Your Core
“During flexion and extension of the knee the iliotibial band has historically been thought to rub over the femoral condyle creating irritation. There is significant doubt about this being a true “friction” created syndrome. ITBS, in most cases, does not seem to be friction syndrome with a “popping” of the tendon over the femoral epicondyle.

Pain Science: IT Band Pain

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