Body Health Blog
The iliotibial band (ITB) is a dense fascia that runs along the outside of the thigh towards the knee and connects the gluteal muscles to the anterolateral tibia. Inflammation occurs from the iliotibial band rubbing and compressing against the femoral condyles during knee flexion and extension. This can be due to biomechanical abnormalities or slanted running surfaces. Symptoms can vary from a dull ache that lingers after a mile or two into a run but disappears soon after you stop. In severe cases the pain can be sharp and the outside of the knee can be tender or swollen, often aggravated with descending stairs.
picture from The Running Advisor
- Biomechanical faults such as pelvic imbalances, over-pronation, knock knees (genu valgus) or bow legs (genu varus).
- Training on indoor tracks, cambered roads and/or running on steep down hill routes.
- Over-training or a sudden increase in training volume and/or intensity.
- Muscle imbalances in the core and lower extremity.
Treatment and Rehabilitation
It is very difficult to continue to train through ITB pain. Runners with mild symptoms should cut back on speed work and avoid down hills. Successful therapy of ITBFS can be achieved by incorporating a comprehensive, kinetic chain–oriented approach. Stretching and strengthening of the lateral pelvic stabilizers are the main priority.
Restoring the band’s flexibility with specific stretching exercises and myofascial release (foam roller) should become part of the injured runner’s daily routine. Strengthening the gluteus medius and tensor fascia lata, which are decelerators of the valgus/internal rotation vectors at the knee.
As shown on the picture to the left, cross the injured leg behind the uninjured leg while leaning in the same direction as the back foot. Place your hand or forearm against a wall for balance and support. Then, it is a matter of flexing the front foot while keeping the back foot anchored. The stretch should be held for at least 60 seconds at a time and performed three to four times a day. Icing the area will help reduce any inflammation. In acute cases, a cortisone injection may be given under the band to alleviate the pain.
Prevention and Recovery
- The fundamentals of adequate warm-up, stretching and strengthening apply.
- Gradual adjustments in training to accommodate new surfaces/venues or the intensity and/or the duration of a training session.
- Avoid steep down hills whenever possible.
- Have your core, pelvic and lower limb mechanics evaluated by your sports health care provider via a functional screen and assessment followed by corrective exercises.
All of the above assessment and treatment methods are provided and available at Armitage & Associates Chiropractic Group.
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