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IT Band Syndrome forces runners to change their routines

Do you have a stinging pain on the outside of your knee? Does it hurt walking up stairs? You might be suffering from IT Band Syndrome. In this latest installment of our running injuries series Dr. Nace describes what it is, what causes it and how you might treat it.

IT Band Syndrome (ITBS) is prevalent in runners because it is based on repetitive movements and it is a common overuse injury.

What is the IT Band?

IT stands for iliotibia and it translates as ilium, which means a bone in the pelvis, and tibia, which means shinbone. The IT band is a thick band of tissue (like a rubber band) that runs along the outside of the leg. It starts on the outside of the pelvis and spans down along the outer thigh and attaches on the outside edge of the tibia (shinbone) just below the knee joint. The IT band’s function is to help provide strength and stability for the knee joint during movement

What is ITBS and what causes it?

ITBS is a common cause of hip and knee pain in runners. It is most frequently felt along the outside of the knee and upper thigh area as well as around the outside of the hip (Greater Trochanter).

Friction of the IT band against the outside of the knee or hip is generally the culprit and it is a symptom of repetitive activities like running. The constant pounding and repetitive motion of running can force the IT band to drag across the knee and/or hip and this friction causes discomfort.

ITBS may also be a consequence of compression of fat and connective tissue under the IT band or a chronic inflammation of the IT band bursa. A bursa is a normal fluid filled sac that sits between bone and tissues to alleviate potential friction. The IT band bursa can become irritated and flare up.

I see ITBS most often in patients who are running hills, have rapid changes in their training regimens and patients who engage in excessive striding.

How can I treat ITBS?

Since ITBS is an overuse injury, the best treatments consist of activity modification and rest.

  • Changes in training regimen
  • Cross-training
  • R.I.C.E. protocol
  • Anti-inflammatory OTCs as tolerated
  • Stretch, stretch, stretch
  • Faster paced running or shorter strides

ITBS is the result of repetitive motions, unbalanced muscle groups or bad biomechanics. Stretching and activity modification are the most effective methods to treat it. I recommend stretching, using moist heat before training and then using cold to reduce the inflammation after the training session. Also, studies have shown that faster paced running or shorter strides are less likely to aggravate the IT band then slow jogging so take this into consideration when training if you have symptoms of ITBS.

For more information on ITBS and treatment feel free to visit the American Academy of Orthopaedic Surgeons at www.orthoinfo.aaos.org.

When to see a doctor?

If symptoms persist longer than 2-3 weeks then I would recommend making an appointment. ITBS is rarely treated surgically but there are some surgical options, including release of IT band. If individuals have tried the treatment options mentioned above and the symptoms have lasted over 12 months then a surgical consult may be warranted.

WalkJogRun Training Diaries and Training Plans can help you avoid overuse injuries. By following a plan that doesn’t increase the mileage, the pace or the amount of hill work by more than 10 percent per week and carefully monitoring your weekly mileage you limit the chances of developing these overuse injuries.

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Written by Dr. James Nace, M.D.: James Nace, MD is an orthopedic surgeon-joint replacement and doctor of general orthopedics specializing in hip, knee and shoulder joint preservation and reconstruction. He practices out of the Rubin Institute for Advanced Orthopedics at Sinai Hospital of Baltimore, Maryland. Throughout his career as a physical therapist and orthopedic surgeon, Nace has gained the most satisfaction from treating runners and all types of athletes for their injuries and helping get them back to training and competing.