Injuries

Iliotibial Band Syndrome: Self-Care & Training Modification

As we work our way through this series, let not forget what we have learned so far.

  • Iliotibial band syndrome is a common overuse injury plaguing runners of all abilities. The most common offense is trying to increase your volume too soon while also increasing the intensity without cross-training or varying surfaces.

  • The Iliotibial band DOES NOT STRETCH! The tension we feel is caused by the muscles that support the IT band, Tensor Fascia Latae and Gluteus Maximus.

  • The stabbing pain we experiences as runners suffering from IT band syndrome is thought to be caused by the band itself shifting forward and backward as the knee flexes and extends. The research is out on that one…if we ever reach a consensus, I will let you all know!

Where are we now? Well…if you have made it this far, you are probably dealing with IT band syndrome and wondering if it will ever go away and let you get back to running the way you would like.

For this, we are going to discuss self-care. What you can do about the knee pain and tight hips at home while also mentioning a few stretches you can do at work or out on a run. Our goal is simple - Allow you to continue to train, modified while improving your IT band syndrome pain week-to-week.

What we are talking about today, where the real work takes place, the day in and day out self-care. And the big question….can you continue training?

 

 

SELF CARE PART 1 - START WITH A BETTER WARM-UP

I can not stress this enough! As you are working through an injury, maintaining some kind of load (training volume) is important, but you are better served spending time on a proper warm up, running just a few miles, then spending a good amount of time on the cool down. With just about every running injury we deal with, runners have a dismal warm-up if one at all. Most are so pressed for time, they lace up the shoes, run out the door, only to return and head straight to work. Most of us are not teenagers anymore, our bodies just can’t do this…not for long periods anyway. Start with a thorough warm-up - we will emphasize this again in our next article where we talk rehab and return to running so prepare yourself!

 

 

SELF CARE PART 2 - SELF MYOFASCIAL RELIEF

Understanding that foam rolling and stretching of the IT band itself is ineffective, where do we focus our attention? The hips…it is always the hips! But some attention at the knee can be beneficial while appropriate rest and recovery are always suggested after an acute flair-up or long run.

  • Rest & Recovery:

    • Traditional pain relievers for running related pain include ice, heat, topical creams like biofreeze, and some good old-fashioned rest. Today we have an array of tools that can aid in recovery, one we like to use frequently are compression boots from Rapid Reboot. We don’t expect everyone just to have these lying around, but they sure feel great after some dry needling, IASTM, and manipulation in the clinic.

  • Rolling & Stretching:

    • Now that we understand what anatomy we need to address, it is time to get your roll on! If we are able to continue to train, we suggest rolling and stretching 4-5 times each day. Before you lose it, these sessions are only 3-4 minutes each. If you are a frequent runner, or just starting out, here are the basics.

    • Rollers should be in your home, office, and car. You should have at least 3 lacrosse balls around, purse, cup holder in your car, in your desk, and your gym bag.

    • Roll in the morning, pre and post run, after your lunch break, when you get home, and then a good session before bed.

  • Cupping & Flossing:

    • These may not be tools accessible to all, but they help you achieve stretching in ways that are difficult to do on your own. One of my personal approaches to provide relief to the knee pain we experience with IT Band syndrome is to place a few cups (I have a few sets of these) around the lateral knee and lateral quadricep muscle, walk about for a few minutes, perform a few squats, rinse and repeat 2-3 times per week.

 

 

SELF CARE PART 3 - TRAINING MODIFICATION

Training modification is the hardest part to address. For most, the ability to continue training toward your race is almost as important as fixing the injury. While maintaining some load is ideal, there are instances where a total shut-down is necessary for a few weeks. If you are a typical runner, meaning that you are going to run through the injury, we must modify. Here are the basics. Remember that Iliotibial band syndrome is the result of too much mileage or intensity, too soon in your training plan. Not having a proper base as you head into a 20-week marathon training plan is a recipe for disaster.

  • Our first suggestion is to cut your volume by 50% and decrease your intensity for the next 2-4 weeks. Our goal is to maintain some running, but the speed work and downhill bombs need to take a backseat for a while.

  • Please, cross-train! As runners, we think that running is it, period. When we are injured, and more so when we are not so that we can prevent injury, we must cross train. If you have been battling IT band syndrome for more than a few weeks, it is time to work in some biking, swimming and weightlifting. This allows you to maintain most of your cardiovascular capacity while taking out the pounding associated with running.

  • Lastly, look at your running form. Can it be cleaned up a bit? For most of us, that is a very strong, Yes! I’m not saying to go out and get an extensive running evaluation to change the subtle nuances of your stride, most of us just are not at that level, but shortening your stride, increasing your cadence, and working on your running drills can provide a needed boost in your running efficiency.

    • Cadence should be upwards of 170-180 steps per minute.

    • Perform drills on a soft surface (track or field) 2-3 times per week.

    • More on this in the rehab portion next week.


Dr. Reheisse is a Board Certified Chiropractic Sports Physician practicing in the Greater Salt Lake City Area of Utah. Revive Sport & Spine provides evidence-supported chiropractic care and conservative sports injury management.

Iliotibial Band Syndrome: Why Runners? Understanding Biomechanics & Common Risk Factors.

Knowing more about the anatomy associated with the Iliotibial band (IT Band Article #1) is a great start, but that alone will not decrease the stabbing feeling you had on the outside of your knee as you attempted a long run this past weekend.

 
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We are moving forward with our IT Band Syndrome Relief series. This time we aim at the biomechanics (boring for some, but very important) of the Iliotibial band and why it is causing you pain. From there, we are going to look at some common risk factors and other things you are doing every time you go out to run that is making it worse.

 

 

BASIC BIOMECHANICS

When we look at the function of the Iliotibial Band, it primarily assumes the role of lateral knee stability. Understanding that it originates from the Iliac crest and inserts on the tibia (Gerdy’s tubercle, remember?) we realize that it is a two joint muscle. When a muscle crosses and acts on two joints, in this case, the hip and knee, the likelihood of injury dramatically increases, especially when it is subjected to overuse overload.

With this setup, the IT Band also acts to extend, abduct (raise the leg out to the side), and externally rotate out the hip. As we will discuss in our next article about self-care for the IT Band, we know the muscle of the hip are the primary culprit and where we will focus our attention during clinical and home care.

BUT WHY THE PAIN AT THE KNEE?

While the Iliotibial band crosses the knee to attach to the tibia (fibular and patella according to some studies) providing stability to the outside of the knee, it moves as the knee bends and extends during walking and running.

 
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When we bend our leg, the IT Band moves anterior to, or forward, across the lateral condyle of the femur bone (SNAP!), then, when the knee nears 30 degrees of bend, it moves posteriorly, or back over the lateral condyle of the femur (SNAP!).

Now, think about how many steps you take on your average 5-mile run. If you have tightness in the hip musculature, namely the TFL and Glute Max muscles, they are pulling tension through the IT Band causing an up close and personal relationship between the band and the femoral condyle we just mentioned. When we work through the running gate cycle, we cross the 30 degrees of flexion and extend back out of it over and over….SNAP, SNAP, SNAP!

Take this friction, and add force. The force from each and every foot slap on the ground while running has to be dispersed through the muscles, ligaments, tendons, and joints. While not proven, my own personal ‘journey’ with IT Band Syndrome led me to find that when I trained on softer surfaces, my knee pain was less severe.

Either way, this force, friction, and the magic number of 30 degrees do not play well together. As you can see in this video, if you run with somewhat decent form, your foot strikes the ground somewhere between 20 and 30 degrees of knee flexion (SNAP!) and when you follow-through the gait cycle to push off and bring your leg forward, you near full extension (SNAP!) and back into bending of the knee (SNAP!).

 

 

COMMON RISK FACTORS & RUNNING MISTAKES

Common Risk Factor #1: Too Much, Too Hard, Too Soon

We have all done it…try to pick up where we left off either from an injury, vacation, or some much needed time off after a goal race. However, this typically affects the newer runner. You find a plan online, it looks fun, doable, but you soon find out it was too much. Increasing your intensity and volume at the same time spells disaster for the most veteran runner, for the newbies, this is the quickest way to stop running. Take it slow, slower than you want to. Build up your volume, EARN YOUR BASE, then maintain that volume and slowly increase your intensity. THERE IS NO OTHER WAY!

Common Risk Factor #2: Not Taking The ‘Road’ Less Traveled

Do you always run on the road? I mean ALWAYS? How about sticking to one side of the road on every run? We all know that roads are banked, but if you are always running on the right side, your body will adapt to that slight lean, causing problems down the road (pun intended there). With that, try the track, trails, aqua jogging, a treadmill. Just like shoes, you need variety. Note: Watch the video above, and look for pt 3, we talk on this more.

Common Risk Factor #3: “What Is Strength Training?” -Runners Everywhere

One of the most common causes of IT Band Syndrome is weakened hip muscles. It will come as no surprise when we discuss clinical and home care that strengthening the hips is a GIANT part of the rehab and future prevention process. It’s okay runners, I was scared of the weights at one point in time too!

Common Risk Factor #4: Who Has Time To Warm-Up?

The next significant change we make during care is the Warm-Up. If you just said, “The What?” Then we just found the cause of your IT Band Syndrome Pain. Warming up not only helps prevent injury, but it makes you a better runner. There, I said it, now start doing it.

Common Cause #5: Developmental & Gait Abnormalities

Overpronation, leg length discrepancies, bow-leggedness, poor hip mobility due to underlying causes. These are all challenging, and for most, they just add to the problem. A perfect example is that I personally found that I have a 1.5 cm short leg. I found this out when I was over 30, my body was adapted to it. Putting a lift in or selecting a supportive shoe would have only worsened my condition. I did, however, have to be strategic in my strength training, mobility work, and where and how I trained. If you fall into this category, call our office, or someone near you that understands running injuries as you do need help from a professional to find the right rehab exercise and mobility drills to help you run pain-free.

 

 

SUMMARY

  • Tight and weak hips lead to poor function and support of the IT Band. This allows the band to SNAP at the knee, producing overuse friction, and long-standing pain.

  • Risks come in all varieties, some you are doing every day. Take your training slow, work in strength training, vary your training surfaces, and warm up before running!



Dr. Reheisse is a Board Certified Chiropractic Sports Physician practicing in the Greater Salt Lake City Area of Utah. Revive Sport & Spine provides evidence-supported chiropractic care and conservative sports injury management.



Resolve Low Back Issues Part 7: What Happens When You Need To Seek Care?

Our intention with this series on Low Back Pain has been to inform and empower you, or your loved ones, to take action and realize that movement can help, as well as, prevent low back pain. That your low back pain is not a life sentence.

While all of this information is useful and should be utilized before, during, and after a Back Pain episode, the reality is that some people will need to seek care.

You have had a front row seat to one pillar of our care, the education and exercise component. When seeking care for low back pain, putting your faith solely in one person, and relying on them for everything is not advised and will severely hinder your progress.

YOU (YES, YOU) HAVE TO PUT IN THE WORK, TIME, & EFFORT!

As a Sports Chiropractor that treats low back pain every single day…we see it time and again in our patients… If home care is not adhered to and a person does not take their situation seriously and put in the effort, back pain will take forever (or it seems that way) to resolve.

Today we are going to give you another up-close look at our care process, this time what we actually do here in the office. Our goals are to (1) Determine the cause of your pain/injury (2) Provide care in the office that helps you toward your goal of running, golfing, sleeping, moving again…pain-free, and (3) Give you the tools and education to help yourself.

We structure our care around 3 pillars: Soft Tissue, Joint Motion, Exercise. We have exhausted our opinion and writing on exercise, please refer to parts 1-6 for direction. Now, lets briefly take a look at what care looks like inside the office.

SOFT TISSUE CARE

JOINT MANIPULATION

 
 

For additional tips on how YOU can relieve back pain, fill out the form below and grab our FREE tips sheet with 12 ways to help you relieve back pain and maintain an active lifestyle.

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Dr. Reheisse is a Board Certified Chiropractic Sports Physician practicing in Cottonwood Heights Utah. Revive Sport & Spine provides evidence-supported chiropractic care and conservative sports injury management.