Iliotibial Band Syndrome (ITBS) is a common injury runners suffer from for several reasons. The iliotibial band (IT band) main function is to stabilize the knee as it flexes and extends. Therefore, when the IT band is not stabilizing properly there tends to be excessive rubbing on the outside of the knee causing inflammation. A few common reasons that this occurs can be do to running up and down hills or stairs, overtraining, poor warm up or cool down, over pronation or excessive supination, a leg length discrepancy, genu varum deformity (bowlegged) or muscle imbalances such as weak hip abductors.
As I have noted in previous blogs it is very important to strength train and stretch to prevent injuries. Gluteus medius and maximus tend to be weak in people with IT band pain causing poor biomechanics during running. According to the research runners that strengthen there hip abductors will experience improvements with ITBS symptoms.
Daily stretching, as opposed to stretching just before or after a run is more effective in maintaining/creating flexibility. If you are experiencing IT band pain, my first recommendation is to stop running and give your IT band a few days, possibly weeks, to rest. During that time I would make sure that you are stretching daily and gradually start a strengthening program. A foam roll is a simple and effective way to work at home by self-massaging the IT band. The foam roll will help break up scar tissue and stretch the tissue out. The IT band itself is difficult to stretch because it is not a muscle, but a band of tissue. After rest period is over, gradually start jogging while slowly increasing your pace in conjunction with a strengthening and stretching program. If the pain returns consider seeing a doctor or physical therapist for further treatment.
The first two exercise below are specific to the treatment of the IT Band. The rest are part of the program prescribed in our earlier blog post on runner’s knee designed to strengthen the hips to avoid runner’s knee.
Self massage with the foam roll
Lie on your side on top of the foam roll with it placed between the hip and the knee. Cross your top leg over the bottom leg and keep the knee bent so you can use it to help roll up and down. Prop yourself on your elbow and slowly start rolling your bottom leg making sure to go just below knee and towards the top of the hip. I would perform about 2 sets of 10 and apply as much body weight as you can tolerate. I recommend no more than once per day and if it is sore the following day hold on performing that exercise. Soreness the first few times is normal and as it becomes less tight there will be less pain.
IT band stretch
In standing place one leg behind the other and lean away from that side pushing your hip outwards until you feel a stretch on the side of your thigh. Hold that position 20 to 30 seconds and repeat 4 times per side.
Side lying hip abduction:
Lie on your side on the floor, slightly roll your top hip forward and extend your hip back. Slightly turn your foot out and slowly raise your leg up focusing on the glutes doing the work. You should minimally feel it in your thighs, if you down extend the hip back a little more. This exercise should be pretty fatiguing. 2-3 sets of 10
Prone bent knee lifts
Lie on your stomach and bend one knee to 90 degrees and slowly raise the thigh up without using the low back. 2-3 sets of 10
Single leg bridge
Lie on your back and with one knee bent and one leg straight slowly raise your buttocks and the straight leg up keeping your hips level. 2-3 sets of 10.
On all fours, cross one leg underneath you and straighten the opposite leg. Next, lean onto the side with the leg that is bent underneath you. Hold 20 seconds, 4 times on each side.
Hip adductor stretch
Sitting up straight or with your back against the wall bend your knees having your feet touch and slowly push your knees down. Hold 20 seconds, 4 times on each side.
Stand on a 6 inch step with one leg hanging off the step, keep the knee straight, and raise the unsupported leg keeping the knee straight. 2-3 sets of 10.
Written by Meredith Franczyk, PT, MPT. Meredith has over ten years of experience and is currently working in outpatient orthopedics at lakeshore physical therapy. Over this time, she has developed specialties in general orthopedics, manual therapy, and sports rehabilitation. Meredith has specific interests in sports related injuries. She takes a keen interest in new methods and advancements in physical therapy practice and has taken multiple continuing education courses to improve her skills and enhance her knowledge. If you have any questions or are looking for physical therapy please contact her at Lakeshore Physical Therapy.