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Iliotibial Band Syndrome - The Basics and Prevention Techniques
By Rick Morris
Iliotibial band syndrome (ITBS) is a rather unique but common running injury. It's one of the more common running injuries because the mechanics of running place a lot of stress on your Iliotibial band (ITB). ITBS is a unique running injury because the actual cause of the injury is not usually located in the same place as it's associated pain and discomfort.
Your Iliotibial band, which is also known as Iliotibial tract or Maissiat's band, is a thick, fibrous band that travels down the lateral side of your thigh from your tensor fascia lata, gluteus maximus and gluteus medius muscles, across the side of your knee to your tibia. You probably are already very familiar with your gluteus maximus or "butt muscle". Your gluteus medius is a slightly smaller muscle that is located underneath and slightly superior to your gluteus maximus. Your tensor fascia lata muscle is located on the lateral side of your hip just in front of your hip bone. Each of those muscle provide a number of services but when combined with your Iliotibial band their primary duty is to abduct your leg or move your leg laterally away from the midpoint of your body at your hip. If you were to lie on your side and raise your leg away from your body you would be abducting your hip and leg.
Anatomically speaking, abduction is the primary purpose of your ITB, but as a runner your ITB fills an even more important role. It controls the adduction of your thigh which is the opposite of abduction. You are adducting your leg at the hip when you move your leg towards the mid line of your body. During the foot strike and stance phase of your running motion your foot pronates or rolls inwards slightly. At the same time your lower leg rotates inward or in a counter clockwise direction. That combination of foot pronation and inward tibal rotation causes your leg to adduct at the hip. Your hip abductor muscles and your ITB team up to control and stop that hip adduction motion.
You can see that your ITB is doing a tremendous amount of work with each running stride you take but that isn't all it's doing. During that same foot strike and stance phase of your running cycle your ITB is performing another critical function. It's preventing the opposite side of your hip from collapsing downward. Without the support of the ITB on your foot strike side your opposite hip would dip down and your stride would collapse. The ITB on your support side is keeping your pelvis stable and keeping your stride even and strong.
The pain associated with ITBS is usually located on the outside of your knee. Since all of the muscular work is performed at or near your hip you're probably wondering why the pain is at your knee. That's one of the things that makes ITBS a unique injury. The pain can be located in the hip area due to a condition called greater trochanter bursitis but that is an associated problem - not a true case of Iliotibial band syndrome. The outside of your knee takes the lion's share of the pain because the ITB rubs over the epicondyle of your femur (bony knob on the outside of your knee). The constant friction leads to irritation and pain at the point of contact.
Your ITB doesn't always pass over your epicondyle. When your leg is straight your ITB passes in front of your epicondyle. As you flex your knee your ITB passes over your epicondyle. It is the repeated flexing and straightening of your knee that creates the friction and irritation of ITBS. When your leg is flexed more than about 30 degrees the ITB travels behind your epicondyle. Most studies agree that your ITB rubs against your epicondyle when your leg is flexed between 20 and 30 degrees. A study from the Australian Institute of Sport found that the friction occurred at an average of 21.4 degrees of flexion.
Avoiding Iliotibial Band Syndrome
You can't avoid flexing your knee during your running stride unless you're using the Frankenstein technique, so is there any way to avoid ITBS. You may not be able to completely avoid all friction caused by your ITB but you can take steps to minimize the problems caused by it.
The first and most important step you should take is to strengthen your hip abductor muscles. If your hip abductors are weak your ITB will need to work harder to take up the slack. A 2005 study at Stanford University found that "...weakness or inhibition of the lateral gluteal muscles is a causative factor ...When these muscles do not fire properly throughout the support phase of the running cycle, there is a decreased ability to stabilize the pelvis and eccentrically control femoral abduction." To make up for that weakness some of your other muscles must try to compensate which can lead to excessive tightness in your ITB and an increase in the friction between your ITB and your knee.
You can strengthen your hip muscles by simply performing side lying leg raises in which you lay on your side and slowly raise your leg away from your body. You see this exercise performed in gyms every day, but that simple exercise isn't running specific. As a runner you want to strengthen your hip flexors using more running specific motions and exercises. Here is a series of exercises that will get your hip flexors in top running condition.
1. Hip Shrugs - You've heard of shoulder shrugs but have you ever done a hip shrug? Start this exercise by standing sideways with your right foot on the edge of your treadmill or a step. Your left foot should be held off the floor and your pelvis should be level with both feet at the same height. Now lower your unsupported left foot by dipping the left side of your pelvis toward the floor. Your body should remain completely vertical. Now raise your left foot above the level of your right, supported foot by raising your left hip up, similar to shrugging your left shoulder. Keep performing that motion for about 50 repetitions then switch legs and repeat.
2. Hip Rolls - This one is similar to the hip shrugs except you will add a rolling motion. Perform the same shrugging motion of your hip but at the same time roll it forwards and backwards in a rotary motion. This is very similar to rolling your shoulder. Keep your support leg and hip stationary.
3. Hip Roll Strides - After you master the hip rolls it's time to make this exercise even more running specific. Perform a hip roll but as you roll your hip up and forward, bring your knee up as in a running stride. As you roll your hip down and back straighten your knee as in a push off during your stride. When done correctly this exercise should feel like a running stride with exaggerated hip rolling motion.
Strong hip abductor muscles will help you avoid ITBS but you can also take some other measures to help you avoid this injury including tweaking your stride and being careful how and where your run. A number of studies including the Stanford University and Australian Institute of Sport investigations found that faster running is less likely to cause or aggravate ITBS because at foot strike the knee is flexed beyond the angle at which friction occurs. Can you adjust your stride to avoid that angle even when running more slowly? In many cases you can by avoiding over striding. When you over stride your foot strike is in front of your body and your knee is less flexed. Your foot strike should always be directly under your center of gravity with more flexed knee. Not only is that type of foot strike more efficient and economical but you will avoid ITBS and other repetitive motion injuries.
Another possible reason that faster running is less likely to cause ITBS is associated with ground time. When you run faster your ground contact time decreases. Less ground contact time can mean less stress on your ITB because you "spring" off your foot more quickly and less leg abduction takes place. When you run concentrate on dorsi flexing your foot so that you are able to use your muscle elasticity with greater efficiency and decrease both your ground contact time and the stress on your ITB.
Where you run and also play a role in ITBS. Running on a short track with tight corners places much more stress on the ITB of your inside leg because you lean towards that leg. The inside lean places more stress on your ITB as it is forced to work harder to prevent excessive adduction of that leg. If you consistently run on a track try to reverse directions frequently. Many track runners have chronic problems with ITBS in their left leg because of the "requirement" of running in a counter clockwise direction on a track.
Iliotibial band syndrome is a common injury that can sometimes become a chronic and debilitating injury. Keep your hip abductors strong, run with proper mechanics and be careful with your track running and you can avoid future problems with this running injury.
Biomechanics of iliotibial band friction syndrome in runners, Orchard JW, Fricker PA, Abud AT, Mason BR, Sports Science and Sports Medicine Centre, Australian Institute of Sport, Am J Sports Med. 1996 May - June;24(3):375-9
Iliotibial band syndrome in runners: innovations in treatment, Fredericson M, Wolf C, Stanford University School of Medicine and Stanford University Cross-Country and Track Teams, Sports Med. 2005;35(5):451-9
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