While the most hardy Mainers continue to pound the pavement year round, most of us probably stick to cushioned treadmills in the gym, or even taking a breather over the winter months. But, whenever it’s time to get back out on the road anytime after a running hiatus, runners in particular, need to be cognizant of developing overuse injuries as they get back into training.  By keeping a few key points in mind, athletes can prevent or significantly decrease the severity of these frustrating (and sometimes devastating) injuries.

What is Iliotibial Band Syndrome?

Iliotibial Band Syndrome (ITBS) is an overuse injury caused by friction between the Iliotibial Band (on the outside of the thigh) and the lateral femoral condyle (outside portion of the knee).  It is most commonly seen in runners, cyclists, and other athletes who are repetitively flexing and extending the knee.   Pain is usually felt in the front/outside portion of the knee and can be extremely debilitating. ITBS accounts for up to 15% of overuse injuries around the knee, and running athletes are at highest risk.   

What causes ITBS?

Common causes for ITBS include a rapid increase in either the volume or intensity of running. A prime example is a runner who has not been running over the winter and returns at the same volume as he or she was running the previous season. Poor arch support from running shoes, particularly in athletes with a tendency to over pronate, also places runners at risk.  

STRETCHING & STRENGTHENING FOR YOUR IT BAND

What to expect from medical intervention

ITBS is a fairly straightforward diagnosis.  However, it is important to see a sports medicine trained physician if you are having persistent pain around the knee that doesn’t respond to simple resting.  X-rays are typically normal in athletes with ITBS.  MRI can be useful in athletes with particularly severe cases in order to rule out more serious issues that may mimic ITBS including meniscus tears and stress fractures.  

On average, 90% of patients engaging in appropriate treatment will have resolution of symptoms within 4-8 weeks.  Treatment initially consists of rest, icing, and oral or topical NSAIDs.  Physical therapy with training modification is also a mainstay of treatment.  Therapy focuses on stretching of the ITB, lateral fascia, and gluteal muscles, deep transverse friction massage, strengthening hip abductor muscles, and proprioception exercises to improve neuromuscular coordination.  If initial attempts at conservative therapy fail to provide relief, a corticosteroid inject may be considered.

Tips for preventing and recognizing ITBS

Keep a running log. Increase your training intensity/volume by no more than 10% per week.

Consider including cross training with an exercise that does not require repetitive knee flexion/extension in your regimen. (i.e. swimming)

Allow a rest day once per week.

Warm up and focus on stretching before your runs.  A foam roller can be particularly helpful to stretch the IT Band.

Make sure you have appropriate arch support from your running shoes. Change your running shoes every 300-500 miles.

If you have worsening pain that comes progressively earlier in your runs and is not relived by rest, or if you have persistent pain, particularly at night, seek an evaluation with a sports medicine physician. 

— Text: Jonathan P. Watling, MD; Orthopaedic Surgery, Sports Medicine