Iliotibial Band Syndrome
 The knee pain that won't quit
Iliotibial band syndrome is a common overuse
injury that causes severe knee pain, and can be
difficult to cure.
Most non-runners have never heard of the
iliotibial band: a stabilizing fascia on the outside
of the leg that connects at the hip and below the
kneecap. It's purpose is to stabilize the leg when
the quadriceps, the big muscles on the front of the
thigh, fatigue.
The quadriceps are the muscles distance runners
use the most: together with the hamstrings, they
comprise the 'primary movers.' The cumulative effect
of long slow mileage is a shortening and weakening
of the quadriceps. When the quads weaken, the IT
bands prevent excessive side-to-side leg motion that
could damage the knees and hips.
The problem with diagnosing and treating IT band
syndrome is that symptoms only appear after the
injury becomes serious. Though tight, sore
quadriceps are easy to feel, tightening of the IT
bands can occur with no pain or noticeable loss of
flexibility.
The runner's first inkling of a problem is severe
pain at the attachment points, that typically occurs
several miles into a run. The pain, which the runner
feels either at the side of the hip or lateral side
of the kneecap, can go away for a period of time,
only to reappear days, weeks or months later.
Compounding the problem is the fact that IT band
syndrome has a variety of causes, ranging from
overpronation or underpronation, leg length
discrepancies, muscle imbalances, an excessive
Q-angle, tight hip flexor, gluteal or quadricep
muscles, or a combination thereof.
It all starts with the feet
Most specialists agree that IT band injuries
begin with the feet. When a runner's feet roll
excessively inward or outward during the gait cycle,
it places more stress on the IT bands, causing them
to tighten.
Not all running shoes are created equal: good
ones are the runner's first line of defense against
iliotibial band syndrome. Specialty running shops
offer gait analysis, to assess how much support a
given runner needs.
There are three categories of shoes, ranging from
motion control models that correct for severe
overpronation, to neutral cushioned shoes for
runners who underpronate or have a neutral gait
pattern. Many runners wear stability shoes, which
provide a moderate amount of arch support.
Sometimes the feet act differently: one may
overpronate, and the other not. Leg length
discrepancies, pelvic rotation and muscle imbalances
are among the culprits. Since shoes can't correct
for different gait patterns in the left and right
foot, an orthotic device in the shoe evens out the
feet, so they function the same way.
Building a strong core
Core strength is key to preventing IT band and
other overuse injuries. When the quadriceps and
hamstrings fatigue, the runner's pelvic muscles take
over to keep the legs tracking straight.
While there's a lot of good information on core
strength training online and in print, it's helpful
to start with a specialist. An experienced coach,
personal trainer or physiotherapist can assess
problem areas, and assign specific exercises to
strengthen the weak links.
Home remedies
The proactive measures mentioned above slant the
odds in one's favor, but they aren't bulletproof.
Iliotibial band injuries can strike the most
cautious of runners, often at the peak of their
training, when they can least afford to take time
off.
If an athlete catches the injury early, it's
possible to continue some training, and still allow
it to heal. Here's some pointers:
Run only on soft surfaces such as packed dirt or
grass. Avoid severe up or downhill grades. If the
surface is cambered, make sure to change sides of
the road periodically. Sometimes one side of a
cambered surface will be less irritating to the
injury than the other.
Run to the point of pain, but not through it.
Since IT band pain typically comes on several miles
into the run, it's possible to run to that point
without making the injury worse. With treatment, the
interval before the onset of pain will grow longer,
and the runner can gradually resume normal training.
Ice massage is the best way to reduce the
inflammation around the painful area. The easiest
way to do ice massage is to fill Dixie cups with
water and freeze them: peel the paper down gradually
to expose a small area of ice and massage the sore
spot for a minimum of five minutes. Do the ice
massage two-to-three times daily until the pain
subsides.
Some runners are flexible enough to stretch the
IT band, others are not. A good sports massage
specialist or physical therapist can promote healing
by releasing tension in the IT bands. Some runners
find that rolling on a foam roller is effective in
reducing IT band tightness.
 Professional treatment
If the pain doesn't subside in a couple of weeks,
it's best to seek professional treatment. Office
treatments not only reduce the painful symptoms of
IT band syndrome: they also expedite healing.
Modalities that reduce inflammation include
ultrasound, cold laser, and electric therapy.
The Graston Technique promotes healing by
breaking up scar tissue that builds up around the
injured area, so the affected muscles, connective
tissue and fascia can heal properly.
Therapists will recommend a specific
strengthening and stretching routine to help the
muscles resume normal function, and reduce the
likelihood of a recurring injury.
For additional information on iliotibial band
injury treatment and prevention, call Alpha
Chiropractic at (480)812-1800.
Back to Chiropractic Resources
 Dr. Carson Robertson is in private practice at
Alpha Chiropractic. His clinic services the
chiropractic, massage therapy, and physiotherapy
needs of the Chandler, Ahwatukee, and Gilbert area.
He has a special interest in athletics, running, and
soft tissue injuries. Carson Robertson DC can be
reached at (480) 812-1800. |
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