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So what is ITBS? Would I be able to run again?

31/07/2009

So I mentioned I have ITB in my past blog entry.  For my non-running readers, I will try to explain it with the help of doing my own homework.

And my colleagues at work kept on asking me too why are you not running/racing at the moment? and I would always say, “I am injured.  I have ITB.”  So Here it is …

What is it? ITB is called by medical practitioners as iliotibial band, a strong thick membrane – not muscle-on the outside of the thigh, and iliotibial band syndrome is the injury (ITBS) of this part of the body.

The iliotibial band originates on the lateral rim of the pelvis and the gluteus muscle where it is wide and thick over the vastus lateralis muscle. Then it travels downward over the outside of the thigh becoming a narrower and denser structure. It then crosses the knee joint on the outside toward the front and attaches to the main bone of the lower leg, the tibia.  Because it is a 2-joint structure, the athlete can have pain/aches or soreness at the hip and/or the lateral knee region.

Running and cycling involve require repetitious extension of the knee joint. This can cause the ITB to shorten and tighten. The tightness then causes pressure on the outside (lateral) aspect of the knee which can cause lateral knee pain. The other common symptom is lateral hip pain, especially if you press on the bony bump (trochanter) on the outside of your hip.

This can be caused by the friction and pressure of the tight ITB across that bony prominence and the associated hip (trochanteric) bursitis.

It is a pain and inflammation on the outside of the knee, where the iliotibial band  becomes tendinous, and results in a friction syndrome by rubbing against the femur (thigh bone) as it runs alongside the knee joint, outside of the pelvis, and over the hip. The band is crucial to stabilizing the knee during running, moving from behind the femur to the front while walking.

Read this, this not just a common injury for runners.

Runner’s knee                                     ITBS
Stiffness in front of knee cap             Pain outside of the knee
Knee hurts on long runs                     Hurts beginning of the run
Pain going down stairs or hills         Pain when climbing stairs or hills

Who are affected by the ITBS:

  • Cyclists.  In cycling, having the feet “toed-in” to an excessive angle
  • If you are Pregnant.  It is also commonly occurs during pregnancy, as the connective tissues loosen and the woman gains weight — each process adding more pressure.
  • The elderly.  ITBS at the hip also commonly affects the elderly. ITBS at the hip is studied less.

Symptoms:

  • Dull ache on a few kilometres during a run with pain for the duration of the run- differs from person to person which kilomter distance with pain  remaining for the duration of the run. The pain disappears soon after stopping running, later, severe sharp pain which prevents running pain is worse on running downhills, or on cambered surfaces pain may be present when walking up or downstairs.
  • Local tenderness and inflammation
  • Stinging sensation just above the knee joint, on the outside of the knee (not in the inner part of the legs – as that is called “Runners Knee”) or along the entire length of the iliotibial band

Causes:

  • The continual rubbing of the band over the lateral femoral epicondyle, combined with the repeated flexion and extension of the knee during running may cause the area to become inflamed.
  • Anything that causes the leg to bend inwards, stretching the ITB against the femur overpronation (feet rotate too far inward on impact) tightness of the ITB muscle lack of stretching of the ITB incorrect or worn shoes excessive hill running (especially downhills) and running on cambered surfaces overtraining
  • Excessive friction of the ITB against the outer bony portion of the femur (thighbone) at the knee.
  • Factors that predispose a person are having a tight ITB, high weekly mileage (of running), walking or running on a track (versus running in a straight line),
  • Weakness of the hip abductors (the muscles that move the thighs away from the body at the hip).
  • Abnormalities in leg/feet anatomy:
    – High or low arches
    – Overpronation of the foot
    – The force at the knee when the foot strikes
    – Uneven leg length
    – Bowlegs or tightness about the iliotibial band.
    – Excessive wear on the outside heel edge of a running shoe (compared to the inside) is one common indicator of bowleggedness for runners.
  • Muscle imbalance
    – Weak hip abductor muscles
    -Weak/non-firing multifidi muscles

Treatment

  • Have your self checked by the Physio :p (those who are sport-minded like you)
  • Rest from running, especially in the case of severe pain if pain is mild, then reduce training load and intensity (2-3 weeks, if it is still there go back to your physio)
  • Avoid downhill running and running on cambered surfaces.
  • Take a course (5 – 7 days) of non-steroidal anti-inflammatory drugs  (ibuprofen/voltaren/cataflam/mobic)
  • Apply ice to the knee (for 10minutes every 2 hours) in order to reduce the inflammation
  • Self-massage, using arnica oil or an anti-inflammatory gel, to the muscle only (along the outside of the thigh). Do not massage the side of the knee where you feel the pain, as this will only aggravate the friction syndrome stretching of the ITB.
  • Remember to stretch well before running
  • Return to running gradually
  • Orthotist or podiatrist for custom-made orthotics to control overpronation, change over used shoes
  • Change your running route, run in bitumen, grass, or clay, Avoid the concrete
  • Treatment may include deep tissue or friction massage which can release the adhesions, trigger point release, ART (active release therapy)

Recovery: Full recovery is usually between three to six weeks

Preventative measures:

  • Stretching of the ITB, quadriceps, hamstring, and gluteal muscles. Hold each stretch for 30 seconds, relax slowly. Repeat stretches 2 – 3 times per day. Remember to stretch well before running.
  • Strengthening of quadriceps, hamstring and calf muscles.
  • Correct shoes, specifically motion-control shoes and orthotics to correct  overpronation
  • Gradual progression of training programme
  • Avoid excessive downhill running, and cambered roads (stay on the flattest part of the road)
  • Incorporate rest into training programme
  • Avoid the following duringg recovery: Running, Stair climbing, Deadlifts or squats, Court sports, such as tennis, basketball, or similar, Martial arts, such as karate (especially where being bare foot emphasises any symptoms being caused by leg/foot abnormalities), Bowling, Wrestling,

The best part!
Returning back to running

  • Gradually get back to running by testing the waters first.  Doing too much too soon can increase the time of recovery.  After a 5-minute walking warm-up, run in a easy paced run on an even terrain and walk back to recover between each one.   If you have pain, continue to rehab and rest.
  • Warm up walking briskly for 5 minutes.  Run at an easy pace for 20-25 minutes and finish with a 5-minute walking cool down and flexibility exercises.  Repeat this running workout on alternate days.
  • Cross-train on the days in between to maintain your cardiovascular fitness.  If there is no pain present before, during or after the run increase your training period by max of 10  10 minutes to the run next time.
  • Gradually add minutes to your runs as your body allows.  Every time you increase minutes hold what you have for 3-5 more running sessions until you reach your normal running regimen.  This will avoid risk for re-injury and doing too much too soon.  Alternate your run days with either rest or cross-training for the first four weeks back to running.
  • Avoid adding speed, hill workouts until you are symptom free for at least 6 weeks and have rebuilt an adequate base of mileage.
  • If pain returns, take 3-4 days off, continue to focus on cross-training, strengthening and flexibility and try, try again.  Your body will recover and be stronger and less likely to develop ITB again.
  • Be cautious about running on tracks, down hills and on crowned and uneven surfaces as it can contribute to ITB.  All of these can contribute to developing ITB.  Running on softer surfaces is more fore giving on the body and may be an easier for the transition back to running.
  • Avoid over striding, find ways to improve stride efficiency.
  • Perform self massage/release techniques with a foam roll or The Stick to help release the tight tissue and decrease tension on the band.
  • If possible, schedule a deep tissue/friction massage biweekly or monthly.
  • Be patient and perform each workout with a goal in mind.  If you’re wise, every run will be one step closer to a complete and successful return.  You may be surprised…and turn a negative into a positive and come back much stronger!
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3 Comments leave one →
  1. jones permalink
    21/11/2009 8:55 am

    Very detail informations. Thanks for sharing!
    I wish i found out about this ITB syndrome earlier.
    After this half marathon i would have to take a good rest and doing the recovery exercise.

    Glad you find the information useful, but then again you always need some GOOD physician/Podiatrist to diagnose you and consult before doing the excercises :). Good luck and hope you recover soon.

  2. Bill permalink
    29/12/2009 12:29 pm

    Most physio’s say that ITBS is aggravated by slow running and to do short faster runs instead during the rehab period. I can not run “slow” for more than 5 minutes, but I can do a 5k faster no problem.

    hm ok… haven’t heard about that before …. maybe! What I understand is, you don’t feel it not after you reach a certain longer distance. You don’t feel the pain at the beginning of the run

  3. 24/12/2011 7:08 am

    Yep the pain usualy comes after the run. Or a point once you get over a certain time since starting. I think the slower and shorter runs are more to build your confidence up again. I would not wish ITBS on anyone. I have had nearly a year off running now I get quite depressed.

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