Injury Prevention Series: IT Band Syndrome

Few sayings are more sagacious than the adage “an ounce of prevention is worth a pound of cure.” Though many trainees would like to prevent injury, specifically ones stemming from an overworked IT band, most don’t know of efficacious modalities often rooted in proper strength training protocols.

IT Band Syndrome

IT band syndrome, clinically known as iliotibial band friction syndrome, is an overuse injury that is prevalent in runners, particularly distance runners. For the elitefts™ faithful who might also engage in running recreationally either for weight management or piece of mind as I do, read on. For those who partake in pick-up basketball games, flag football on the weekends, or in other sport leagues as many of us do or will do at some point, the information presented may be of assistance.

The iliotibial band (IT band or ITB), or iliotibial tract as its also referred to, blends from the tensor fascia latae (TFL), which originates from the iliac crest, posterior to the anterior superior iliac spine (ASIS). Blending from the TFL, the IT band continues down the lateral third of the thigh, passing over the greater trochanter (GC). It’s at the greater trochanter where fibers from the gluteus maximus, TFL, and IT band become intertwined. Traveling further down the leg, the IT band blends into the fascia of the vastus lateralis, which originates from the GC, and crosses the knee joint where it attaches at two sites—the proximal outer aspect of the tibia and the outer aspect of the patella.

Knee Flexion

During knee flexion, which occurs at initial contact in running gait, the IT band translates posteriorly alongside the lateral femoral epicondyle. The repetitive nature of running coupled with poor running mechanics, unsustained running pace, and running in shoes with worn down soles can cause the IT band to tighten. Tightened IT bands during knee flexion impose greater frictional forces upon the patella, which in turn can cause knee mistracking and create or exacerbate existing knee pain. Knee pain associated with IT band syndrome typically presents itself laterally, specifically near the lateral femoral epicondyle. However, the pain might be experienced throughout the entire knee joint and might even radiate to the hips and lower leg. Walking and other exercises such as jogging where the active flexion extension is limited (occurring within the first 35 degrees of flexion) might also cause pain and should be reduced or avoided if possible. Remember, IT band syndrome is an overuse injury, so try to avoid activities that got you there in the first place.

Outside of correcting structural discrepancies such as differing lengths of the bones of the upper and lower leg and severe genu varum, which may also contribute to IT band syndrome, there’s a lot you can still do. A quick note—while overpronation of the ankles can be due to a structural discrepancy best addressed by orthotic and prophylactic devices, it, too, can be an adaptive discrepancy and can be corrected with hip lateral rotation and transverse abduction exercises.

First off, those engaging in running activities need some sort of soft tissue work such as self-myofascial release (SMFR) with a variety of implements or more preferably a manual modality such as the Graston technique. While the latter may not be affordable to all, I’m sure forking over a 2.6 x 6.1 inch picture of Andrew Jackson in exchange for a foam roller is an option that’s feasible for most.

SMRF

I recommend incorporating SMRF prior to stretching and immediately following runs and other forms of strenuous physical activity to reduce sympathetic tone. SMRF should be conducted on the days that you aren’t running or working out as a recovery modality to help break up adhesions within the fascia. SMFR is also effective in shifting fluid balance in the tissues, thus promoting better blood flow. Collectively, each objective of SMFR will improve soft tissue pliability and, in conjunction with specific stretches and mobility drills, will help restore muscles back to their proper resting lengths.

A comprehensive strength training program should be in place as to bolster resistance to nagging injuries, thereby focusing on strengthening the gluteal musculature. Bilateral and unilateral supine hip extension exercises (performed either on the floor or from an elevated position with the shoulders supported on a sturdy surface) should be incorporated and can be made progressively more challenging by loading them with a barbell, plate, dumbbell, sandbag, bands, or chains. Improving glute strength will influence stride length, thus improving running economy. Let’s face it—most distance runners aren’t strong enough in the first place. Even resistance trained recreational runners lack sufficient posterior chain strength, as the quadriceps and lower leg musculature is getting hammered through the high frequency and lower amplitude of longer distance runs. Rarely, with the exception of a final kick, is there any considerable hip separation or knee flexion occurring at fifty degrees or greater during runs exceeding 800 meters.

Prevention

Here are some takeaways for preventing IT band syndrome:

  1. Keep a close eye on your mileage. What is considered a high volume is relative. Those who will inevitably catch the running bug in the beginning of the year with hopes of shedding a few pounds should curb their zealousness. More isn't better. Remember, progressive overload is the key to not only adaptation but preventing injuries.
  2. If you don’t already, hit the weights with zeal. Because you’re frequenting this site, you likely are unless you’re trolling. Shift your lower body work to posterior chain work, devoting much of your attention to strengthening the glutes. Also, focus on the hamstrings, training them both in extension and flexion.
  3. Soft tissue work is critical. Foam roll the quads, adductors, hamstrings, and lower leg musculature. Take a tennis ball to the plantar fascia. Realize that restoration work will improve your performance and alleviate the hypertonicity of overactive muscles.
  4. Invest in quality shoes and know when to replace them. Many experts suggest rotating your shoes for runs. I would go further and say that you should not only do that but have shoes for different activities. Wear basketball shoes to play basketball, lifting shoes or flat soled sneakers to lift in, and Sketchers Shape Ups never unless your name is Joe Montana and you’re getting paid $500,000 to wear them for a thirty-second commercial.
  5. Maintain a constant running pace. This should be much easier when you take heed to the four aforementioned prevention guidelines.