Preventing and Treating IT Band Syndrome

My Personal Struggle With IT Band Syndrome

I began running cross-country competitively in the 4th grade and continue through my Junior year in college. As you long-distance runners know, struggles with injuries are not uncommon due to the high stress placed on your body. Stress fractures, IT band syndrome, torn ligaments, over extensions and other injuries plague the athletes of today’s world.

The first time I remember experiencing knee pain was in high school after an especially challenging hill workout. I ignored it, as any “tough” runner does, and it continued to worsen. The athletic trainer reprimanded me for waiting so long to come see him. Early intervention with knee pain caused by ITBS can lead to an easier recovery.

I soon became familiar with the necessary stretches, strengthening activities, and RICE (Rest, Ice, Compression, Elevation) to help my knees recover. Unfortunately, I had waited too long to get medical treatment and was subject to 4 weeks with no training whatsoever to make sure no permanent damage had taken place.

You can already tell where this story is going. Seek treatment early for any knee pain, and you may be able to avoid stopping training. My goal for this article is to help you avoid problems before they develop, and help treat problems if you are already having pain.

What Is IT Band Syndrome?

Iliotibial Band Syndrome (or ITBS) is an injury caused by overuse and is characterized by pain or tenderness in the outer part of your knee and thigh. Iliotibial Band Syndrome is most commonly found in both cyclists and runners due to frequency knee involvement in these exercises. IT Band Syndrome pain is caused by inflammation in the tissue running from the iliac crest (hip) to your lateral knee. This inflammation causes your tissue to rub unnaturally, leading to scarring, decreased range of motion and pain.

IT Band Syndrome is characterized by knee pain felt as tenderness on the outside of your knee. Knee pain can be debilitating for athletes who are training and can limit progress. 

What is the Iliotibial Band?

The iliotibial band is a thick tendon that attaches to part of your shin-bone (or tibia), and runs up, across your knee, and attaches to your iliac crest or hip. This tissue is important for stabilizing your knee, and helping your hip to rotate properly when walking or running.

IT Band Syndrome Causes.

Causes of IT Band Syndrome include the following:

  • Exercises with increased knee flexion (squatting, running, weight lifting, bicycling)
  • Over training or increasing your mileage too quickly (greater than 10% per week)
  • Poor flexibility in the muscles of your hips, knees, lower back, calves and thighs.
  • Running downhill causes significant stress on your ileotibial band and joints
  • Anatomic abnormalities like uneven leg lengths or bowed legs
  • Training mistakes like running consistently on uneven surfaces
  • Improper posture while biking
  • Ignoring early knee pain, leading to scar tissue formation

Runners are at higher risk of developing IT Band Syndrome due to the frequency of heels striking the ground. Bicyclists are also at risk for developing IT Band syndrome due to the stress placed on the knee during when riding a bike.

Best Stretches for IT Band Syndrome

There are multiple stretches useful for stretching the muscles surrounding your IT band, decreasing pain, and increasing flexibility. You should complete these stretches at the very least, before and after your workouts, and for approximately 15 seconds on each side. As your flexibility increases, you may wish to get a deeper stretch. Follow the instructions below to achieve the stretch right for you. Stretching should never be painful. If you experience pain, decrease the amount of the stretch and adjust accordingly. As you stretch more, your flexibility will increase and your stretch will get deeper.

Stretching before every workout is important in preventing injury, or preventing a current injury from getting worse.

Crossed Leg Twist

Instructions: Sit on the ground, stretch both legs out in front of you. Then bring one leg over the other, twist your upper body towards the bent leg, and stretch the opposite arm across your knee. Switch sides and repeat. To get a deeper stretch, twist your body further and apply pressure to your knee with your arm.

Crossed Ankle Stretch – Folded Over

Instructions: Start in a standing position, cross one leg over the other, and lean over to fold yourself over. Try to touch the ground with your fingertips. Switch legs and repeat. For a deeper stretch, try placing the palms of your hands on the ground.

Quadriceps Stretch- Standing

Instructions: Start in a standing position, bend your knee behind you, and take your ankle into your opposite hand. For a deeper stretch, pull slightly harder on your ankle while leaning back at the same time.

Quadriceps Stretch- Side Lying

Instructions: Start in a side plank position. Bend your knee behind you, and grab your ankle with the same sided arm. For a deeper stretch, pull your ankle further up, drawing your knee further behind your hip.

Gluteous Muscle Stretch- Standing

Instructions: Start in a standing position, draw your knee up to your chest. Repeat on the opposite side. This stretch can make it difficult for you to balance. Make sure you keep your knee straight, and try to focus on something still in the distance to help improve your balance.

Gluteous Muscle Stretch- Seated

Instructions: Start in a seated position on the ground. Lie back, cross one leg over the other. Grab behind your back knee and draw it up towards your chest. Repeat on the opposite side. For a deeper stretch, pull your knee closer to your chest.

Foam Rolling

Foam rolling is an important step in both prevention and treatment of IT band syndrome. Foam rolling has many benefits:

  • Breaks up scar tissue
  • Increases blood flow to damaged tissues
  • Promotes the release of lactic acid
  • Decreases pain
  • Increases flexibility

This exercise benefits your health by increasing your flexibility, decreasing recovery time, decreasing pain, and increasing blood flow to your damaged muscles.

Instructions: Start in a sitting position on the ground. Position the foam roller underneath the part of your leg you would like to stretch. Support yourself with your arms and opposite leg. Slowly lower yourself onto the foam roller, applying more pressure by lessening your resistance against the ground. Stretch your hamstrings, quadriceps, and gluteous muscles by gently rolling the foam roller underneath you. You may need to ice your muscles before completing this stretch to help numb them. Your muscles can be tender during the first time foam rolling.

Exercises to Prevent IT Band Syndrome

These exercises are aimed at preventing problems through improving your balance, hip alignment, and muscle strength surrounding the iliotibial band.

Balancing on one leg

Instructions: lift one leg off the ground, balancing on one foot. Try to do this for approximately a minute, and then switch sides. For a more challenging balance, you can close your eyes and put your arms out to the side. This exercise is simple, but helps to strengthen the muscles surrounding your IT band and increases the stability of your knee and hips.

Squatting with one leg

Instructions: Lift one foot off the ground in front of you, then squat as deep as you are able to safely. Make sure your knee does not go past your toes. Switch sides and repeat. For a more challenging stretch, see the picture above. This exercise strengthens your gluteus muscles, which increases the stability of your IT band.

Treating IT Band Syndrome

The first line treatment for treating this syndrome is aimed at decreasing the pain and swelling through the mnemonic RICE.

R- Rest – rest is the most important part of healing an IT band injury. Continuing to do exercises that worsen your pain will lead to further scar tissue formation, swelling, and pain.

I- Ice- Icing the outside of your knee, hip, and IT band helps to decrease both swelling and pain. Icing for up to 20 minutes every hour is ideal. Anymore and you may risk frostbite or damaging your tissue with the cold. Icing is also helpful before foam rolling, which can be painful initially. Icing has an added benefit of numbing the area, helping to break up scar tissue more effectively through foam rolling.

C- Compression- Wrapping your knee with an ace bandage or using a knee brace helps to stabilize your knee, taking pressure and strain off of the IT band. Compression also helps to decrease pain.

E- Elevation – Elevation decreases tissue swelling by letting gravity help to draw the extra fluid back towards your body, where it can be removed from the body by your kidneys. It is important when you elevate your leg to make sure that it is above the level of your heart to get the best effects. Lying down, elevating your leg and icing at the same time is the most effective way to decrease swelling and pain all in one.

A doctor may also prescribe an NSAID (non steroidal anti-inflammatory drug) like ibuprofen or Tylenol to help decrease swelling and pain. Alternative treatments include electrotherapy like a TENS unit to decrease pain. Some physicians may also recommend acupuncture, steroid injections, and massage to help decrease pain and swelling.

Good luck out there, athletes. Treat your body well and it will do the same to you.

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