For 10 years, an article on a treatment for iliotibial band syndrome (ITBS) by podiatrist and competitive runner Brian Fullem has remained one of the most popular on our website. Here Fullem revisits the topic, adding new exercises he’s learned or developed that address the underlying issues better than ever. ITBS remains one of the main causes of knee pain in runners. The IT band, or ITB, as it is commonly known, can become so painful that a runner is unable to train at all. Mark Fadil, now director of Sports Medicine Institute International (SMI) in Palo Alto, California, knows this injury personally and professionally. As a high school senior in 1991, Fadil won the New York state 3200m championship in 9:10. After one successful collegiate year, Fadil developed pain on the outside of his knee on the fourth day of his sophomore season. He was diagnosed with ITBS and, even though he was receiving regular treatment—including NSAIDs, ultrasound, stretching and two cortisone injections—the pain progressed to the point that he could not even run a mile.

Nine months later, he turned to renowned Irish physiotherapist Gerard Hartmann, and after 11 days of deep-tissue massage, stretching and strengthening, he was able to train again, finishing his career at Stanford University as a team captain with an 8:50 best in the 3,000m steeplechase. “You need to address both the cause and the symptom,” Fadil says. runner's world top womens running shoesFortunately, we now know more about the causes, and hopefully runners can prevent the problem earlier.top running shoes for comfort What It Is, What Goes Wrongnike basketball shoes april 2014 The ilitotibial band is a fibrous structure that assists the stability of the leg during the stance phase of the stride, works with the hip muscles in abduction (outward movement) of the thigh, and helps to resist torsional movements around the knee joint. nike flat shoes images

The ITB begins in the hip as the tensor fasciae latae muscle and ends below the knee joint, inserting into the tibia at a bump known as Gerdy’s tubercle. When the ITB becomes stressed through repetitive overuse, runners most commonly feel pain in the lateral (outside) portion of the knee, above where the ITB crosses the joint. nike shoes custom designThis condition is sometimes accompanied by a clicking sensation, caused by the ITB snapping across the joint. nike high tops jordansThe pain usually occurs just after heel contact and gets progressively worse as the run goes on. Downhill and long, slow running tend to cause an increase in symptoms. ITBS typically starts with tightness on the run and often advances to the point where the pain is debilitating. While the ITB will become tighter when it is injured or overstressed from excessive training, this tightness is not the root of the problem.

The cause of this injury lies in the function of the ITB and weakness surrounding it. The ITB is not a strong structure; any weakness in the surrounding muscles can lead to injury. Runners are notoriously weak in their hip and core muscles, particularly if they haven’t done any strength training or participated in sports that involve side-to-side movement. In 2000, Michael Fredericson, a doctor at Stanford University, discovered that weakness of the hip abductor muscles (mainly the gluteus minimus and gluteus medius) was the leading cause of ITBS. Research in the interim has only served to prove that Fredericson was correct in his original assumptions. In 2007, Brian Noehren, Irene Davis and Joseph Hamill reported in the journal Clinical Biomechanics that studying 3D kinematics of female runners revealed those who develop ITBS have an increased hip abduction motion, along with greater knee internal rotation, both likely caused by weakness in the hip abductors. Brian Fullem serves on the Board of the American Academy of Podiatric Sports Medicine and practices in the Tampa, Florida, area.

Iliotibial Band Syndrome, or ITBS, is a common overuse injury among runners. Although the injury occurs because of inflammation of the tendon near the outside of the knee, the problem often arises from tightness in the Tensor Fasciae Latae (TFL), a muscle of the hip that inserts into the Iliotibial band. Causes of ITBS As you run, hip muscles work together to stabilize the pelvis. The longer you run, the more likely these muscles are to become fatigued. Once fatigue sets in, the hip has a tendency to sag in a side-to-side motion with each stride, which can also cause the knee joint to move inward towards the midline of the body instead of staying in line with your foot. strong How to Aggressively Treat IT Band Syndrome Athletic trainer Michael Busby, who works specifically with runners, says that weak hip abductors such as the gluteus medius (smaller muscle located on the side of the hip/gluteus) can be an indirect cause of ITBS in running-related injuries. "Weak hip abductors such as the gluteus medius won't likely cause ITBS on their own," he says.

"But with prolonged lower-extremity movement such as running, weak muscles become exposed, forcing your ITB and the TFL to work harder than they should. The harder they work, the tighter they'll become." While a tight ITB does directly result in inflammation, strengthening the gluteus medius is a must in order to improve hip strength and avoid pain, particularly on long runs. Strengthening the Gluteus Medius One exercise that Busby recommends for gluteus medius strengthening is called clamshells. "Clamshells are a great exercise to start with. If your hip abductors are weak, start out doing them with both legs at once." strong Tight IT Band? 3 Simple Exercises to Fix it NowOne of the most common running injury is the Iliotibial Band Syndrome, otherwise know as the IT Band Syndrome! Note: This information is advice given from one runner to another, and not meant to be taken as a medical consultation. Your best strategy in diagnosing and treating any injury is to see a doctor who wants to get you back out there running.

He or she will keep trying various treatments until something works. When that type of doctor tells you that you need to stop running for a while (because it is a stress fracture, etc), you should do just that. Ask the most experienced runners in your area for the names of medical specialists in the area of your injury, who’ve helped other runners heal quickly. When a doctor barely listens to you, and quickly tells you to stop running, it’s time for a second opinion. Sometimes even the best doctors miss something. There are times when you should talk to 2-3 highly recommended specialists to get the whole picture. Almost all of the runners I’ve communicated with about I-T Band injuries have been able to run during the recovery period, once the healing had started. Many of these folks have continued their marathon training program, after making the adjustments for the injury. Once you’ve determined that the healing has begun, and your training stays below the threshold that could further irritate the injury, you’ll probably be able to continue your running.

The first priority, however, is being conservative enough (with slower pacing, more walk breaks, and days off from running) to allow the healing to continue. Almost always on the outside of the leg, from the knee to the hip. The pain from I-T band is most often felt on the outside of the knee, slightly below the intersection of the two leg bones. For some, pain may be centered just above that point. In rare cases it may hurt on the outside just below the hip, and occasionally the pain may radiate up and down the outside of the leg, at various times. We will concentrate on the most common site, the outside of the knee. A strong muscle just below the hip, the tensor fascia, is connected by a long band of connective tissue that acts as a tendon, going down the outside of the leg, and connecting to the shin bone below the outside ot the knee. Even when the wobbling proceeds for some time, this band of tendon tries to keep the leg from excess motion. Once the tendon itself loses its strength, and continues to be pushed beyond it’s capacity it gives way at the point of most stress.

This is most commonly where the tendon connects below the knee. A bursa sac, which tries to smooth out the operation of the knee and protect the tendon from the bone, may also become irritated. Some runners strain the tendon itself, others pull away the connections below the knee, the tendon and the bones. A second area of irritation is that just above the knee, due to the friction of the tendon repeatedly rubbing the bone slightly above the knee joint on the outside.If you back off soon enough, it’s possible to run enough to do the marathon, while it gets better. You will have to reduce the speed of every running segment and put more walking into your runs, more often. The longer you continue to irritate the injury, the longer it will last. Even after you start back, you must monitor the injury for the next few months. Even after the pain goes away from an injured area, there is still damage inside. One run that is done too fast (or without enough walk breaks) can bring back the damage, often worse than it was before.

How does it get injured? As long as the leg muscles are resilient, and you’re not doing very much more training than you’ve done in the recent past, the leg system will stay in its track and adapt to slight increases. When you push your main running muscles too far, the primary running muscles get too tired to move you ahead and stay within the natural range of your foot and leg. In other words, your legs start to wobble. The further you go when wobbling, the more you will injure the area. You may not be able to pinpoint what caused the problem, but here are the most common causes. Treatment I’ve spoken with hundreds of runners who’ve run through I-T band injury. You want to get permission from your doctor to do this. the healing needs to have started, and you must stay below the threshold of irritation. In other words, you need to keep from further injuring the area. If running 4 miles leaves it feeling worse the next day, run no more than 2-3 miles, every other day. If it stays injured when walking 1 minute after 3 minutes of running, then run 1-2 minutes and walk 2-3 minutes.

It never hurts to be more conservative in your running when injured. By running too much you’ll prolong the duration of the injury. Most of the time, you don’t realize what is too much until you’ve injured yourself. That’s why it’s always better to back off at the first hint 1. Take enough time off to get the healing started (usually 3-5 days) 2. Take vitamin C. When I have an injury such as I-T band, I take 1000mg of Vitamin C, 3-5 times a day. Consult with a sports nutritionist for further information about vitamin C and other nutrients which can speed healing. 3. Stretch the tendon. The I-T band is one of few running injuries that is helped by stretching. Start with the stretches recommended and experiment to find ones that reduce or eliminate the pain. You can stretch before, after, and during a run‹and even in the evening, or while sitting at your desk at work. Stretching primarily reduces the tension on the tendon so that it doesn’t hurt for a while. By keeping the I-T band flexible you also reduce the continued pulling on it, and may help it to heal to some extent.

Experiment with different stretches for the area. The best ones are those that release the I-T band at that time, giving you instant relief. Compare stretches with other I-T band sufferers, but very few runners will use the same stretch routine. You will find that different stretches help at different times, even on the same run.Freeze a paper cup and every night, rub the ice directly on the area of pain until it gets numb (usually about 15 minutes). Be advised that there’s usually no healing effect from ice in a plastic bag, towel or frozen gel pac. It helps to ice the injury immediately after a run, but even if you miss this opportunity, ice it well at least once a day. 5. Run on level surface. Uneven surfaces will fatigue the muscles and tendons and increase the chance of I-T band irritation. A road that is slanted can cause I-T band problems on one run. 6. Get the right shoe and possibly an orthotic. Even the perfect shoe (whatever that is) will lose support from the midsole, usually without any outward sign on the shoes.

To run on these shoes usually aggravates the injury. Shoe experts, (such as the ones in really good running stores) can advise you in finding current shoes which can give the support or cushion your foot needs. Overpronated floppy feet show some shoe wear on the inside of the forefoot and benefit from motion control shoes. You’ll have to give them feedback how the shoes feel and whether there are any discomfort areas. The shoe should be an extension of your foot without any extraordinary pressure or tension.Cross friction massage may speed up the healing. Consult with a running massage expert and you can learn this simple technique. Massage to other muscle areas may also speed up the healing process. 8. As a last resort.Under doctor’s direction: anti-inflammatory medication and/or cortisteroid injection (i.e. cortisone) may get the healing started. Get several opinions before you agree to this, and go to the most experienced and competent doctor you can find. See a new product we are carrying, a FOAM ROLLER to help your ITB!