Just three little words: Iliotibial band syndrome

ITBSITB. The three letters runners dread to hear.

With marathon season fast approaching, and with the long runs for those training now hitting 18 miles or more, this is the time that injuries begin to creep in, particularly among those whose bodies are not yet used to the 40 miles plus each week that they are being put through.

Among the many injuries associated with running, iliotibial band syndrome or ITBS, is one of the most common, accounting for between 8% and 10% of all running injuries. And frustratingly I now find myself part of this statistic.

The fact that I’m not alone in this latest injury provides little solace, and on the off-chance you are suffering too, I wanted to share some of my research.

ITBS is characterised by a pain running down the outside of the knee, which begins as a dull stiffness and develops into a sharp or burning pain. It is caused by the inflammation of the iliotibial band, a thick band of fascia that connects the outside of the knee to the outside of the pelvis, running over the hip and knee joints.

As the leg swings during running, the band moves from behind the femur to in front of the femur. One suggestion of the cause of ITBS is that the continual rubbing of the band over the lower femoral epicondyle combined with the repeated flexing and extension of the knee during running causes inflammation.

STRETCHThe pain associated with ITBS usually occurs a mile or two into a run and is exacerbated by running downhill.

Studies show that ITBS commonly occurs as inexperienced runners start increase their mileage close to a big race – usually two or three months ahead of the event. It is even more likely if the long run is longer – up to two or three times as long – as the single longest other run during the week.

The good news is that, if caught early enough and treated properly ITB issues can be dealt with quite easily.

A 1993 study found that total immobilisation of the affected leg for three days effectively cured almost all acute ITBSs. This was followed by use ice and anti-inflammatories to alleviate the pain.

For those not able to achieve total immobilisation due to the realities of everyday life and work, rest, stretches and anti-inflammatories do help.

Stretches should focus on the muscles that pull on the IT band rather that the band itself – so the glutes, quads and calves. This is because the ITB is not a stretchy tissue – think more car tyre than rubber band – moreover, stretches that claim to target the IT band don’t actually stretch it very much, since it attaches to the femur at several places.

04Similarly foam rolling should focus on the muscles around the ITB, not the band itself as you may suffer further inflammation.

If you can get some slack back into the ITB then it should stop rubbing helping to take the inflammation down.

The simplest stretch is to lie on your back, bring your left knee up to your shoulder, and push your knee over to the right shoulder with the palm of your left hand. Hold for 20 seconds, and repeat five times. Then do your right knee. Do this exercise at least three times a day.

Runners Connect also has some good stretches, as does Runner’s World.

ITBS can also be a result of poor biomechanics, in particular imbalances in the hips. Studies have connected hip abductor and external rotator muscle weakness with ITBS.

It is so important therefore to ensure that you correct your running style and strengthen these other muscles as part of you rehabilitation, as without fixing the mechanical error causing the issue, you will only end up suffering from it again.

In a strong runner, the muscle groups around the hips keep the hip abducted and the knee externally rotated, which limits the strain on the IT band. But when these are weakened, the hip adducts and the knee internally rotates after impact with the ground, crushing the IT band and the underlying sensitive tissue against the lateral femoral epicondyle.

The nerve endings sandwiched between the ITB and the femur are supposed to send signals to the glutes to fire when the IT band is being compressed, but when these muscles are weak this protection mechanism fails. Instead of the gluteus medius and the other main hip abductors firing, the TFL (tensor fascia lata) muscle fires, which puts even more strain on the IT band.

The solution is to strengthen your hips as well as stretching your glutes.

Add these five hip-strengthening exercises to your routine just 2 to 3 times a week, you will increase the stability of that core region. This should hopefully result in fewer injuries (and may just translate into faster times in the long run).

Side Leg Raises: Lie on your side with your legs stacked on top of one another. Lift your top leg to about 45 degrees and then lower it back down. Repeat 15 to 20 times per leg.

Bird Dog: Get on all fours on the ground. Focusing on balance, lift your right arm and extend it straight out in front of your body. Simultaneously, lift your left leg and extend it out behind your body. Bring your extended arm and bent knee back to center under your body, and then extend them both out again. Repeat 15 to 20 times on each side.

Hip Hikes: Standing on one foot, drop the right side of your pelvis a few inches downwards while keeping the left side in a neutral position. Activate your left hip muscles and lift your right side back to the starting position. Repeat 15 to 20 times on each side.

Single-Leg Bridge: Lie on your back with both legs bent and your feet flat on the ground. Lift your left leg off the ground and extend it while you raise your lower back and butt. Hold the position for two seconds and lower back downwards in a controlled manner. Repeat 10 to 15 times on each leg.

Donkey Kicks: Get on all fours again, but this time you will only be lifting and extending your legs, keeping your hands on the ground. Instead of extending the leg backwards like you did during Bird Dogs, keep the knee slightly bent and kick upwards, with the bottom of your shoe facing the sky. Repeat 15 to 20 times on each side.

I hope this is helpful and that I will be back to running again before too long but until then, happy stretching!


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