Ahh the IT Band, the bane of many a runner. A very common injury, Illiotibial Band Syndrome (ITBS) usually presents itself as pain on the outside of the knee where the IT Band inserts into the joint. Before we delve into causes and rehab, let's look at the function of it.
The IT Band is a thick piece of connective tissue that runs down the outside of the thigh from the hip to the knee. It attaches along the gluteus maximus and tensor fasciae late (TFL) on the side of the hip and connects to the lateral side of the tibia. It's main function is to help move the hip in multiple planes of motion and stabilise the knee from collapsing inward during walking and running.
What causes ITBS?
First off, the IT band is not a muscle, it's a tendon that attaches a muscle to a bone to allow movement. This means tendons work completely different to a muscle in that they don't contract and relax and are designed to be stiff and under constant tension to allow muscles to leverage off them for movement. So no, ITBS isn't caused by a 'tight' IT Band.
It was also once thought that ITBS was used by excessive friction between the IT band and the femur, however recent understanding shows that the IT Band has certain structures underneath it that could be causing pain. It's thought that compression of these structures due to abnormal movement of the femur, such as the knee collapsing inward is what causes ITBS.
So what causes abnormal movement of the femur? Typically its a weak butt. The glutes are one of the major muscle groups that control the position of the pelvis and thus stability of the leg during running stride. If the pelvis is unstable, the IT Band puts compression on the structures underneath by pulling away from the knee and causing pain.
How do we recover from ITBS?
Stage 1: Rest - It's the word every runner dreads but it's important to allow a reduction in the inflammation/compression we've experienced. How long depends on the individual, but around 7-10 days is a good starting point. The key is that you don't start running again until pain free.
Stage 2: Strength - Engage in low level strength training 3-4x/week following the routine below to help strengthen the hips and glutes. You can engage in walking if there is no pain during it.
Stage 3: Return to run test - Complete the following tests on the injured leg to determine if you're ready to return to running once pain free.
- Walk for 30 minutes
- Hop on the spot for 30 seconds
- Perform 15 lunges
- Hop forward 10 times
- Hop backward 10 times
If you don't experience pain during these tests and the pain doesn't get worse over the next 12 hours then you're good to go. Give it at least a week off running before you try these!
Stage 4: Slow increase of volume - One of the biggest risk factors to getting injured in the first place is doing too much, too quickly. This means increasing weekly mileage more than your body can handle or running too far without the requisite strength endurance. Build back up slowly, continue to incorporate strength training and mobility work into your programme and listen to your body!