ITBS or IT Band Syndrome

Not sure if I had posted this before but I since I've been having some improvement with my knees, I thought it would be a good idea to post this topic.

It's been years since I discovered I was unable to run due to major knee pain. Because of the intensity of it I was confused about the possible reason of it, and with so many possibilities it is hard to figure out what could be the source of the pain. A brief description of the pain I experience is, it starts on the distal (lower part) and the lateral (external side) part of the knee, extending to the proximal (upper) side of the knee. My condition is, or at least was, so advance, that I couldn't run a mile without feeling so much pain that even walking, after I would stop running, would be extremly painful.

Before I discovered I had ITBS I had consulted with a Chiropractor but he wasn't sure because the X-rays I had done didn't show anything wrong, he suggested for me to get an MRI and see in detail the inside of the knee. Not having insurance and not wanting to pay $300 per knee scan, I let it go and didn't pay more attention to it. My solution? Not run anymore.

The problem is that the pain not only happened when I would run, but also when going downstairs a lot (let's say if I was moving stuff from upstairs downstairs, after a few times using the stairs, I would get the pain, not going up but going downstairs. Also when doing long walks I would experience a less intense pain.

I decided to look up for a video I once saw online about stretching the IT (Iliotibial) Band since in a couple of times I was told that the pain could be caused by the ITB Syndrome. After finding the video, I decided to do another search in YouTube but instead of putting IT Band Stretch, I wrote ITB Syndrome and I found a video which pretty much describes my pain.

After seeing those videos, I was convinced that in fact I have ITB Syndrome. Now I want to share both the stretching video and the explanation about the syndrome in case anyone relates.

So what have I done about it? Well, I started using the foam roller either everyday or every other day. I'm also using the Easy 5k app on my phone to traing properly and I started using what I consider the most important and helpful item that has made my IT Band less painful, which is the IT Band Straps. Thanks to all of these, I now I can run about almost 3 miles before I start feeling discomfort on my knees. This is great news because it means it is working. I'm hoping as time goes by I can finally run without any pain at all.

These are the videos I had mentioned above.

http://www.youtube.com/watch?v=0gVawB-is4A&feature=related

http://www.youtube.com/watch?v=c9aJtO0VCqw
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Replies

  • The_WoIverine
    The_WoIverine Posts: 367 Member
    Some article I found online.


    New Treatment for IT Band Syndrome Yields Results
    By
    Brian Fullem, D.P.M.

    Published

    November 1, 2004


    Iliotibial band syndrome (ITBS) can be a debilitating injury to a runner. The IT band, as it is more commonly known, can become so painful that a runner is unable to train at all. Mark Fadil, the Director of Sports Medicine Institute International (SMI) in Palo Alto, CA, knows this injury both personally and professionally. As a high-school senior, Fadil won the New York state 3,200m championship in 9:10. After one successful collegiate year, Fadil developed pain on the outside of his knee on the fourth day of his sophomore year. He was diagnosed with IT band syndrome and, even though he was receiving regular treatment—including NSAIDs, ultrasound, stretching, and two cortisone injections—the pain progressed to the point that he could not even run a mile. Nine months later, he turned to physiotherapist Gerard Hartman, and after 11 days of deep tissue massage, stretching, and strengthening, he was able to train again, finishing his career at Stanford as a team captain with an 8:50 best in the 3,000m steeplechase.

    What It Is, What It Does, What Goes Wrong

    The IT band begins in the hip as the tensor fascia latae muscle and has attachments at the origin from three different muscles: the gluteus medius, gluteus minimus, and vastus lateralis. The muscle becomes a fibrous band of tissue as it progresses down the thigh, then crosses the knee joint, and inserts along the lateral (outside) portion of the patella (knee cap) and into the tibia (shin) bone on a bump known as Gerdy's Tubercle.

    The classic symptoms of ITBS are pain along the lateral (outside) aspect of the knee joint, sometimes accompanied by a clicking sensation. The click is a result of the ITB tightening and snapping across the joint during running. The symptoms are often worse when running up or down hills.

    ITBS is typically progressive, starting with tightness and often advancing to the point where the pain is debilitating. The traditional view on the cause of this injury has focused on the tightness of the structure and overtraining. There is no doubt that the ITB will become tighter when it is injured. The tightness, however, is more than likely a result of the injury and not the actual cause. The cause of this injury actually lies in the function of the ITB.

    The main functions of the ITB are to assist the hip muscles in abduction (outward movement) of the thigh and to stabilize the lateral side of the knee. The ITB is not a strong structure, and if the surrounding muscles have any weakness that can lead to injury and ITB syndrome. Runners are notoriously weak in their hip and core muscles, particularly if strength training or participation in sports that involve side-to-side movement are lacking.

    In a study published in the Clinical Journal of Sports Medicine (July 2000), Dr. Michael Fredericson, a physical medicine MD at Stanford University, compared 24 runners with ITB syndrome with 30 healthy runners and found the injured runners to have statistically significantly weaker hip abductors (mainly gluteus medius and minimus) than the non-injured runners.

    Phases of Treatment

    Traditional treatment of ITBS has focused mainly on stretching. While stretching plays an important role in the treatment of this injury, there are several other forms of therapy that need to be incorporated.

    Given current research, treatment for ITBS should be in phases. The first phase requires a proper diagnosis and the identification of any causative factors. Once this is established, the next phase is aimed at reducing the pain. Rest may have to play a part during this phase, which also may include physical therapy modalities, ice, and stretching three times a day. Cross training that does not aggravate the condition can be done to maintain fitness.

    Deep tissue massage along the full length of the ITB can be started in this phase; Dr. Fredericson refers to this as mobilization of the tissues, and it is a necessary step before moving on to the all-important third phase of strengthening the hip and thigh muscles. Fadil recommends very frequent massage: up to every day for elites, and 2 or 3 times per week for recreational runners. If you cannot afford the expense or time of going to a certified massage therapist, a foam roller can work very well for self massage (see www.smiweb.org to obtain rollers).

    In Dr. Fredericson's study, the injured runners were enrolled in a six week standardized rehabilitation protocol with special attention directed to strengthening the gluteus medius. After rehabilitation, the females demonstrated an average increase in hip abductor torque of 34.9 percent in the injured limb, and the males showed an average increase of 51.4 percent. After six weeks of rehabilitation, 22 of 24 athletes were pain free with all exercises and able to return to running, and at a six-month follow-up there were no reports of recurrence.

    Exercises for Recovery and Prevention

    If your pain has successfully been reduced, the first exercise that can be performed is side leg lifts. Fadil instructs his patients to use a thera-band for strength work. These large rubber bands come in different strengths and can be ordered from any medical supply store, or one with handy clips and cuffs can be purchased at www.tomdrum.com. Detailed instructions and photos of all stretches and exercises are available at Stretching and Strengthening Exercises for Iliotibial Band Syndrome.

    Not a Pronation Issue

    In some cases, after therapy, stretching and strengthening have been performed then a custom orthotic device may be considered. Patients may benefit more from a cushioned type of orthotic as opposed to a rigid, motion-controlling device. Dr. Doug Richie, President-Elect of the American Academy of Podiatric Sports Medicine (www.aapsm.org), has never been able to establish a clear-cut relationship between any foot types and the propensity to develop this injury. He states, however, that he has almost never seen this injury in runners with flexible flat feet that overpronate; most runners with ITBS would be classified with feet nearly normal or with a slightly higher arch.

    Run Fast, Not Long

    Fadil credits Vin Lanana with the finding that faster running is less aggravating to this injury, so strides may be initiated when the pain level has been sufficiently reduced and until the ITB is healed enough to begin normal running. As with most injuries, the longer you have experienced symptoms the longer it may take to recover. Adding strength work in addition to the previous treatment mainstays of stretching, icing and massage should get you back to form much quicker.
  • SunshineGRL76
    SunshineGRL76 Posts: 108 Member
    Thank you so much for posting this!! I greatly appreciate it.

    I've had problems with my knees, since I was a competitive swimmer in high school. Over the years, I would notice pain while performing various activities (skiing, hiking, golfing, etc), and just wrote it off as 'getting older'. It got to the point of being painful while climbing a flight of stairs.

    I just recently I learned that my IT band was 'damaged' and now I am working on 'recovery'. I have yet to meet with my orthopedic surgeon / sports medicine doctor to discuss this injury, as I have been working with my chiropractor.

    Reading your post today has inspired me to talk with my sports medicine doctor.

    Glad to hear that you are able to run again!! Thank you!!
  • kcritter77
    kcritter77 Posts: 162 Member
    Bump to read more in depth later.
    Thanks!!
  • The_WoIverine
    The_WoIverine Posts: 367 Member
    You're welcome. I know how frustrating it is when you have such impediment due to pain. I even got to the point that surgery was going to be a solution to the problem, but now I know is not.

    Ideally, going to a sports medicine doctor or a massage therapist with plenty of experience in sports massage would be the best solution for ITBS, but money can be an issue for many of us, at least it is for me. So the foam roller is definitely something, that as painful as it can feel, will be part of my tools to get better. I'm looking into the rumble roller for a deeper work once I manage to adapt to the foam roller.

    Good luck and I hope you your knees start getting better soon.
  • JoanB5
    JoanB5 Posts: 610 Member
    Yay! Glad you have found something to help you get moving again!
  • The_WoIverine
    The_WoIverine Posts: 367 Member
    This is an article I found last night about ITBS. The really don't talk about what exercises should be done, and they only mention the Gluteus Maximus and Gluteus Medius. Truth is, they make reference to strengthening the hip muscles, and that includes many more muscles than just those two.

    Hip Muscles:
    Gluteus Maximus
    Gluteus Medius
    Gluteus Minimus
    Tensor Fasciae Latae
    Adductor Brevis
    Adductor Longus
    Adductor Magnus
    Pectineus
    Gracilis
    Iliacus
    Psoas Major
    Externus & Internus Obturators
    Piriformis
    Superior & Inferior Gemelli
    Quadratus Femoris

    Based on other online articles and blogs I've read, they mention how important it is to strengthen the hip abductors. If you search online, you will find a great variety of exercises to strengthen the gluteus group as well as the abductors of the hip. An easy way to strengthen the abductors is with a resistance rubber band like in this picture below.

    Hip-abd-with-TB-finish.JPG

    In any case, here's the new article I found.

    Strengthening beats stretching when it comes to this common running injury.

    ALEX HUTCHINSON
    The Globe and Mail
    Published Sunday, Jun. 24 2012, 4:00 PM EDT


    They call it the “other” runner’s knee injury. Iliotibial band syndrome was the topic of a special session at the annual meeting of the American College of Sports Medicine earlier this month, and for good reason: While it’s less familiar than the cartilage problems that cause the classic “runner’s knee,” it remains the second most common running injury , accounting for about 25 per cent of overuse injuries, and also afflicts many cyclists.

    The results presented at the meeting suggest a new approach to dealing with iliotibial band pain. While traditional rehab has focused on lengthening and loosening the stubborn band, early results from a study by the University of Calgary’s Running Injury Clinic show that strengthening the hip muscles may be more effective – not only for rehab, but for preventing the injury in the first place.

    The iliotibial (IT) band is a tendon-like length of connective tissue that runs along the outside of the leg from the hip to the knee. The classic symptom is pain on the outside of the knee that gets worse after you’ve been running for a while, caused by the IT band pressing in and irritating fat tissue underneath it. Pain at the hip is also possible. The problem is usually blamed on a short, tight IT band, so the typical first line of defence is to relieve pressure by stretching the IT band to lengthen it. One stretch involves thrusting the bad hip outward while balancing on the bad leg and crossing the good leg in front of you – a complicated move that produces equivocal results.

    “It’s like yanking on a tough, old piece of leather,” says Reed Ferber, a professor of kinesiology at the University of Calgary and head of its Running Injury Clinic. “It’s very difficult to actually change its length.”

    More importantly, it’s not clear that the problem is really caused by an IT band that’s too short. In a study presented at the ACSM meeting, researchers from the University of Kentucky compared nine runners with IT band syndrome to healthy controls. To their surprise, they found that the injured runners actually had longer IT bands on average, but weaker hip muscles.

    That suggests that runners with IT band pain should try strengthening their hip muscles – which is precisely what Dr. Ferber and his colleagues tested. In their pilot data presented at the ACSM meeting, they put nine runners with IT band problems through a six-week rehabilitation protocol that involved stretching, hip-strengthening and using a foam roller to self-massage the IT band.

    The results showed that, despite stretching, the flexibility of the IT band didn’t change. On the other hand, hip strength did increase – and all nine runners were able to resume running pain-free. Dr. Ferber believes the foam roller acts primarily to dull the pain sensations from the leg rather than cure the root problem (a hypothesis he’s testing separately), leaving hip-strengthening as the key element in the program.

    Since that initial study was completed, Dr. Ferber and his colleagues have treated a total of 23 IT band patients with the six-week protocol, which focuses on the gluteus maximus and gluteus medius muscles. The runners started with about 30-per-cent less hip strength on average than healthy runners, and after correcting this deficiency, all returned to running pain-free.

    Not all cures will be so straightforward. In some cases, the tissue around the IT band may be so inflamed that it is aggravated by just performing the strengthening exercises. Complete rest and anti-inflammatory drugs like ibuprofen may help. Plus, training factors such as running on hilly terrain can inflame IT problems. For cyclists, full leg extension can be a problem; lowering the seat so that the knee never straightens beyond about 30 degrees provides temporary relief.

    Once the acute pain has been relieved strengthening seems to be the best bet. And during that rehab process, runners are encouraged to keep running to whatever extent they can without triggering pain. “I rarely, if ever, tell people to stop running entirely, except in certain cases like stress fractures,” Dr. Ferber says. “That’s not the answer – you have to fix the underlying problem.”

    Source: http://www.theglobeandmail.com/life/health-and-fitness/fitness/running/strengthening-beats-stretching-when-it-comes-to-this-common-running-injury/article4365074/
  • oohmercyme
    oohmercyme Posts: 279 Member
    Not just stretches, get yourself a foam roller! It will make you cry at first, then it will be your best friend!
  • The_WoIverine
    The_WoIverine Posts: 367 Member
    Not just stretches, get yourself a foam roller! It will make you cry at first, then it will be your best friend!

    Yes, I'm using the foam roller, but this article makes a lot of emphasis on strengthening, which makes me wonder if that's what I'm missing to help with ITBS. The roller helps, but I'll give the hip abductor strengthening a try as well.
  • san0322
    san0322 Posts: 58 Member
    Bump to read later.

    Diagnosis: Gluteus Medius Tendinosis
  • bannedword
    bannedword Posts: 299 Member
    My chiro does Active Release Therapy which has all but cured me of my ITBS. I still use my foam roller from time to time, but my chiro is my savior.
  • jonnyman41
    jonnyman41 Posts: 1,031 Member
    bump
  • RudHart64
    RudHart64 Posts: 53 Member
    Very informative...Wish I saw this a couple years ago!
    Can really relate to this as I had a partial tear in my ITB ....Injured it during a soccer game..simple turn, start to sprint and felt like a claw grasping my hip ...step 1 pinch , 2 pinch...3 burst of hot radiating down leg. took me almost 2 full years to recover back to running and then it tightened up again and caused alot of pain in the knees.... more therapy , stretching, yoga ... now all seems to be back on track ...knees still hurt on occaision and hamstrings still tighten up but a good strtech usually relieves the pain.
  • ItsCasey
    ItsCasey Posts: 4,022 Member
    I know it's fairly expensive, but advanced neuromuscular massage does a world of good, not just for ITBS but for any kind of chronic range of motion issues. I foam roll every day before and after my workouts, but there's only so much you can do on your own. I try to see my therapist every 4 to 6 weeks. She works on a lot of athletes in this area and is very familiar with the kind of muscle and joint issues active people deal with.
  • The_WoIverine
    The_WoIverine Posts: 367 Member
    I'm a massage therapist, so I thinking maybe I could find someone to trade with who has taken a seminar on Active Release Therapy. I was reading about it last night and it sounds a lot like myofacial release. I'd like to give it a try.
  • Persephone7676
    Persephone7676 Posts: 91 Member
    Good information here. I am a cyclist, I do run for cross training. Currently I'm down and out with IT band issues. I'm in the middle of getting the inflammation down and then next step is strengthening hips abductors. I'm pretty sure having a loose bolt on my cycling shoe is what got my IT band started being inflammed. I thought I was OK then went on a ride and found out about 20 miles in I really was NOT ok. Massive pain getting home, it was absolutely excruciating. I pedaled the last 15 miles with my right leg. I'm curious how long I need to let it recover from the initial inflammation before I start strengthening exercises for my hips?
  • almomnc
    almomnc Posts: 68 Member
    bump
  • jherold41300
    jherold41300 Posts: 27 Member
    THANK YOU SO MUCH for all this information. I tore my ACL completely in half playing indoor soccer in OCT 2007, had surgery in Jan 2008 to have my ACL reconstructuted and have had nothing but problems since. Being that I am in the military running for the fitness test is a requirement to stay in the military. When I explained to my knee doctor the pain I was having he diagnosed me with IT Band Friction Syndrome and gave me some stretches to do. At first the stretches were great and I was seeing some relief from the pain but I was still running quite a bit and still having pain in my knee. The pain in my knee got so bad because I was running so much that I could barely walk and my doctor told me that I had to stop running completely in order to give my knee time to heal. Well the military is not very understanding of issues like this and gave me X amount of days to get ready for my next fitness test. My next test rolled around and bc of the pain I missed my run time by soemthing like 10 seconds and when I got done running my knee instantly swelled up and I could barely walk. It got to the point where I was getting cortisone injections to help alleviate the pain and my doctor told me that I was to walk for any upcoming fitness test. Now I am sitting in a position where the military is evaluating my knee issue to kick me out. This IT Band Friction Syndrome has severely limited all of my activities I used to be very active playing sports, running, riding my bike and palying with my neices and nephews and now it seems anything I do aggravates my knee. I just wish my doctor had given me some of this information a couple of years ago so I would not have to worry about wheter the military is planning on kicking me out or not. I will definitely be trying some if not all of the stuff recommended in the articles you posted!
  • supp79
    supp79 Posts: 10 Member
    great information!
  • almomnc
    almomnc Posts: 68 Member
    I think I may break down and see a chiropractor. I am still having problems with the ITB and now I have a lot of pain at night on my sides. My hips hurt and it has to be muscle or ligament pain. Both sides hurt now and the only position that is comfortable is my back or stomach with no pressure on my knees (pushes hips). This has nothing to do with age ...
  • TheGymGypsy
    TheGymGypsy Posts: 1,023 Member
    Ugh ITBS is the bane of my existence. It was improving vastly until I upped my mileage, and around mile 9-10 the pain is unbearable! No amount of rolling, stretching, or strengthening has done me any good. I just have to take an ibuprofen before the pain starts and pray that I can finish.