Despite best-laid plans, a vetted training schedule, excitement for getting in those double-digit long runs, and foam rolling sessions each week, I still got surprised last weekend by a sharp, stabbing pain on the outside of my knee.
The diagnosis: Iliotibial Band Syndrome (ITBS). The result: hobbling around so frustrated that I was on the verge of what my mother would call a “hissy fit.”
I wouldn’t wish this on any runner; but according to my chiropractor, it’s one of the most common injuries to plague our community. All my runner friends gave me a “been there!” along with their condolences. Even if you aren’t one of the millions of athletes who have had ITBS before it’s likely that, as a serious runner, you will someday find yourself with a pain in the thigh, so it might do you some good to read on and learn about prevention and treatment of ITBS.
1. Why Does My Knee Hurt Like a MoFo? A common misconception is that pain on the outside of the knee is attributed to the knee itself. In a few cases of more extreme injury that might be true, but often this pain is caused by an inflamed ligament (the IT band) that runs from the outside of the hip all the way down to the shin and along the way attaches to the knee to stabilize it. This ligament is one of the strongest in your body, and when irritated at the knee joint produces a pain much like a knife digging into the knee. You can even feel pain up in your hip. When my IT band became inflamed at mile 5.5 on an out and back, I knew I had a long walk back.
2. How Does One Go About Irritating Your IT Band? The IT band is connected to your hip, glutes, quads, knee, and hamstrings. If anything is weak or goes wrong in any of these areas, you run the risk of irritating your IT Band, and she is a fickle mistress. So a number of factors can contribute to ITBS, including running on worn-out shoes, muscle imbalances, increasing mileage too quickly, running downhill too aggressively, or not wearing a tank top on Tuesday.
Ok, so I’m kidding on the last one, but ITBS could be caused by so many things it’s ridiculous. I can list off a few things that may have attributed to my BS ITBS. I had a severe ankle sprain last fall that could have lead to a weakness on the injured side. I’ve also started trail running on a path that includes a significant up-hill portion as well as a significant gravely down-hill portion that I’ve been blasting down (WEEEE!!!!) in what I thought was proper form, but could have irritated a pre-existing hip imbalance.
3. Say I Have ITBS Pain, But I Ignore It. What Will Happen?
Typically, ITBS is something a runner can’t ignore or even run through unlike some other injuries. Even if you can tolerate the pain, the knee stiffens up and your range of motion is impaired. Your IT Band will overthrow your authority and make you stop running.
4. What Do I Do When ITBS Gets Too Painful To Run? When you finally limp your way back home, immediately stretch .I like the pigeon stretch, which is also a good stretch for your butt muscles that Salty blogged about here. To see a how-to video go here. Foam roll from knee to hip and pack on the ice. The cruel nature of ITBS is that the pain typically goes away after you stop running, but will reappear if you start back up too quickly. I went to my sports chiropractor who performed some Active Release Technique (ART) and Graston to loosen up the tightness and adhesions the IT band may have developed on other muscles, and to increase blood flow to the area. The IT Band is a super tough fascia to treat with foam rolling and stretching alone, and I highly recommend finding a professional who is certified in the above-mentioned techniques if your pain is severe.
Fight the urge to run if you can still feel pain or soreness when walking or running easy. I know how it is; this can be the hardest advice to adhere to. You don’t have to sideline yourself to the couch eating chips and salsa watching American Ninja Warrior (but it’s delicious and captivating!). Think of this as your time to cross train. Bike riding, rowing, using the elliptical (if it doesn’t cause pain), and pool jogging can be effective activities to bide your time off the road.
5. How Do I Prevent ITBS?
There is no escape!! No no no…I kid. There are likely plenty of you who are blissfully running without injury. But for those already in pain and for those preparing for the worst, there are some things we can do to minimize the chances of getting sidelined by our IT bands…
…Strengthen your leg muscles! This includes exercises for your hips, quads, glutes and hamstrings. And while I know many of you are groaning, remember that running alone is not an effective form of strength training. Allspice provided some great exercises in her post about the butt. Don’t forget about lunges, weighted or the body weight variety, and squats. In the CrossFit gym, a workout to not skip is deadlift day. When done correctly, a deadlift will test your glutes and hamstrings.
If you have any more questions about the BS that is ITBS please leave them in the comments!
How many of you have had this issue and how long did it take you to recover? How do you do your best to prevent or minimize ITBS?