For the avid runner, there is nothing like feeling your feet pounding the ground with each step or the high you get when a good run is done. It’s called ‘runner’s high’ for a reason, but that high can come crashing down when injury strikes.
One injury, iliotibial (IT) band syndrome (ITBS), is the bane of a runner’s existence. Estimated to affect up to 52% of runners at some point in their lives, it causes aching or sharp pain outside the knee, which can run up the quadriceps muscle to the hip.
What is the IT Band?
The IT band is a thick band of fascia that runs along the outside of the leg from the top of the pelvis and inserts into the top of the tibia (shin). Think of the IT band as a rubber band running outside the leg. As you run, the leg goes back, tightening the IT band and building up energy (like a rubber band that is pulled taut), which is then released to propel the legs forward.
Why Does IT Band Syndrome Occur?
The exact cause of ITBS is not fully known. It was previously believed to be caused by friction occurring as an overly tight IT band moved over the lower edge of the thigh and knee, irritating the underlying soft tissues. It is now argued that the pain is caused by a pain-sensitive fat pad located on the outside of the knee.
“Sometimes the IT band is tight due to weakness in the hip abductor; other times it may be caused by gait issues, such as a crossover gait where the feet cross over the body’s midline,” said Dr. Chris McKenzie.
How to Treat IT Band Syndrome
The knee-jerk solution for ITBS is foam rolling, but according to Dr. Chris McKenzie, “there are lots of people who will say not to foam roll.” This goes against the results he sees in the clinic. “We always use some sort of soft tissue or foam rolling technique for these people, and they benefit tremendously.” He also recommends and has seen excellent results from shockwave therapy in patients who did not get better from foam rolling.
However, as with most injuries that occur because of overuse, weakness or dysfunction is often the culprit, and no amount of rest or foam rolling will be enough.
How Physical Therapy Can Help IT Band Syndrome
Going to a physical therapist who specializes in treating athletes, such as those at McKenzie Sports Physical Therapy, is critically important. The PT must be able to examine the body as a whole and identify areas of weakness or dysfunction rather than focusing strictly on where it hurts.
Everything flows down from the hips, so assessing lateral hip strength and stability, as well as the ankle and feet, is very important.
Dr. McKenzie states, “The patella, or kneecap, is of particular importance because, in most people with IT band syndrome, it does not glide medially as it should.”
When the knee does not glide as it should, it can move inward, compressing the pain-sensitive fat pad, irritating the distal IT band, and stressing the knee joint.
“Strengthening the gluteus medius and hips is important, but strength alone won’t solve the problem,” said Dr. McKenzie. “There has to be some carryover training to neuromuscular control with jumping and landing.”
Dr. McKenzie and his team also pay attention to a person’s gait and how their feet land with each step when identifying the underlying cause of ITBS. How a person moves their body when running is critical on many levels, and ignoring this vital part of the evaluation process will result in the issue never entirely going away.
“Foot pronation cannot be overlooked because sometimes when the foot pronates – or the inside arch collapses into a flatter foot posture – the knee follows the foot and dives inward,” he said.
Next Steps
Addressing IT band syndrome requires a comprehensive approach. Consulting a physical therapist specializing in treating athletes is a crucial first step to identifying your pain’s underlying causes. By considering factors beyond the knee, such as hip strength, gait mechanics, and foot pronation, a tailored treatment plan can be developed to help you overcome ITBS and return to running pain-free.