ITBS

Tom Craggs

Iliotibial band syndrome (or ITBS) is a very common issue for runners and one of key knee issues we are asked about frequently. This page provides a bit of advice on how to manage and prevent ITBS which can become a chronic, painful and debilitating injury. This article is best viewed on a tablet or desktop computer. Many thanks to Elite European Triathlon Champion, India Lee, and XC runner Mel Wilkins who provided much better demonstrations than I would have. 

1. What is it? The Iliotibial band is a band of fascia, connective tissue which extends from the hip down to the knee whose role is to stabilise the knee. The glute max and tensor fascia latae (TFL) muscles control the origin of the band and it inserts at the lateral epicondyle (the little bony prominence) of the tibia. ITBS is commonly caused by the friction or rubbing of the IT band over the lateral epicondyle.

2. Diagnosis & warning signs. It's very important to get properly diagnosed by a sports doctor or a physiotherapist. ITBS is some confused with, or found in conjunction with other knee pain such as patellofemoral pain syndrome and to a lesser extent issues such as chondromalacia patellae. An accurate diagnosis is the critical first step in getting over knee pain and this article should not be used as a replacement for diagnosis or individualised treatment protocols. Warning signs of ITBS include pain, tenderness and sometimes a burning or friction feeling on the lateral (outside) aspect of the knee. If you feel the pain gets worse going downstairs or worsens as you run, but eases when you stop running these are all indictions you should get checked out for a possible case of ITBS. Over time this pain can become chronic and affect the movement and function of the patella creating an aching feeling inside the knee itself. 

3. Common causes. The ITB itself is a very strong band of fibrous tissue and in itself cannot be stretched or loosened off. Instead pain is commonly caused by tightness higher up at the TFL - a small muscle on the outside of the hip. This can occur due to a wide number of reasons from incorrect footwear to poor glute and core strength, a narrow or 'cross over' stride and combined with building up your training too fast or increasing the amount of hill training your are doing. This is why it's important to get checked out by a professional who can devise an individual rehab programme for you and provide direct treatment for the affect areas. Below we provide a bit of basic advice and some at home exercises you can do to help prevent ITBS but this does not negate the need to seek individualised advice if you are suffering from ITBS. 

4. Management and prevention. Below we outline some of the key basic exercises runners can do to prevent the onset of ITBS. In all honesty these exercises are just good, day to day running conditioning exercises and aim to strengthen the glute max and glute medius muscles as well as stretching and releasing muscles and connective tissue around the hip and knee area. Please note that directly trying to stretch or foam roll the IT Band itself has very little scientific efficacy and may just exacerbate the problem. Complete the routine below a minimum of 3 times a week, or even up to daily if you know you suffer with these issues or train to higher volumes. 

Step 1) Release. Self massage using a foam roller or massage ball on your quads (lateralis), TFL at the top of the hip (not on the IT Band itself), glutes and piriformis will help to ease some of the tighter spots and trigger points. Ideally look to get a regular sports massage from a qaulity sports therapist - considering a practitioner who can also dry needling.

Step 2) Stretch. Regular daily stretching for your glutes, lower back & TFL, quads and hip flexors is the next step in the protocol. Hold each stretch for 40-50 seconds. Note you cannot stretch the IT band directly. 

Glute & piriformis roll
Quad & TFL roll
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Step 3) Strengthen. One of the key reasons a runner will pick up ITBS is due to weakness in the muscles supporting the hip. These basic day to day strengthening exercises are a key part of preventing and rehabbing for ITBS. Complete 3-5 sets of each exercises for 30-60 seconds each set.

* Clam. Lie on your side with your feet tucked up and raise and lower your top knee without letting your hips roll backward through the movement. Repeat up and down to feel a burn in the glute medius muscle in the hip. 

* Abductions. In the same position now straighten the top leg and again raise and lower ensuring your hip does not roll backwards or forwards. Repeat the clams and abductions on both sides. 

* Banded side step. With a thera-band just above the knees take a semi squat position and ensure there is some tension against the band from your legs. Take small sideways steps ensuring there is resistance against the back throughout the movement. Repeat leading with the other leg.

* Finger crusher. Lie on your back and place your hands undertake arch in your lower back. Engage your lower abdominal muscles and pelvic floor to flatten your back and crusher your fingers into the floor. Ensuring your maintain pressure eon your fingers carry out very small alternate leg lifts never allowing the pressure on your fingers to ease.

Glute stretch
Lower back stretch
Quad stretch
Hip flexor stretch
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Step 4) Activate. Having completed the set of more isolated exercises above it's time to activate all the muscles in the running movement with a more compound exercise. Choose between the single leg squat or the arabesque below but work hard to maintain proper form. The single leg squat is performed in front of a mirror, sitting back and down with your hips but only going as deep as you can without letting the knee collapse inwards or hitching the hip. If you master the single leg squat the arabesque can be a useful addition. Compete the movement from a standing position working to keep a flat, level back and not allowing your hip to open up or hitch. Complete 3 sets of  45-60 seconds. Tom Craggs, January 2017.

Clam start
Clam finish
Abductions start
Abductions finish
Side step start
Side step transition
side step finish
Finger crusher start
Finger crusher applied
Finger crusher with leg lifts
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Single leg squat / arabesque - start
Single leg squat - movement
Arabesque - finish
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