I recently subbed a few cycling classes for a fellow instructor who was taking some time off to recover from pain associated with Iliotibial band syndrome (ITBS) which is a common injury to the knee, generally associated with running, cycling, hiking or weight-lifting. She was training for a marathon while teaching five indoor cycling classes per week. Needless to say, all of this contributed to what she described as debilitating hip pain and prolonged severe discomfort from the knees, all the way down to the toes.
In this post, I wanted to explore the causes, symptoms and treatment for ITBS.
The iliotibial band is a thick band of fascia on the lateral aspect of the knee, extending from the outside of the pelvis, over the hip and knee, and inserting just below the knee. The band is crucial to stabilizing the knee during running, as it moves from behind the femur to the front of the femur during activity. The repeated flexion and extension of the knee during running may cause the area to become inflamed.
ITBS symptoms range from a stinging sensation just above the knee joint, to swelling or thickening of the tissue in the area where the band moves over the femur. The stinging sensation just above the knee joint is felt on the outside of the knee or along the entire length of the iliotibial band. Pain may not occur immediately during activity, but may intensify over time. Pain is most commonly felt when the foot strikes the ground, and pain might persist after activity. Pain may also be present above and below the knee, where the ITB attaches to the tibia. It will also hurt if you twist your knee to turn a corner.
ITBS can result from excessive training with no recovery or proper balance in workout activities. Running, cycling and hiking long distances are some of the major causes. In addition, improper stretching and possibly wrong footwear can be contributing factors to ITBS.
First and foremost, you need to scale down your training regimen to incorporate enough recovery, rest and to work on healing the affected muscles. You also need to increase the strength of your hip abductors (the muscles that help keep the legs out, away from the body) when walking or running. Hip abductors are typically weak in long distance runners. When they are weak, the iliotibial band gets overworked when the hip is abducting. It is therefore, vital that these muscles (and other stabilizing muscles) are strengthened to an adequate level to take the burden off the iliotibial band.
Treating ITBS incorporates several approaches, such as (in no particular order):
- R.I.C.E.: Rest, ice, compression and elevation is the best way to treat initial (onset) IT band pain.
- Physical therapy / Message Therapy: If you have access to a PT or a specialized message therapist, treatment will greatly reduce pain and accelerate healing.
- Reduce activity: If you are teaching/subbing too many classes or participating in back-to-back triathlons, you definitely need to reduce the stress and wear on your hip joints and lower body muscles.
- Foam rolling: Use a foam roller to release the tissues (or a musle roller stick which is easier to pack when travelling). A 6-by-36-inch foam roller is the best tool for stretching the ITB. Lie on your side with the roller under your leg and roll it from your hip to your knee (see right), using your body weight to knead the area. The pressure will help loosen the tendon and the fascia, almost like a self-massage. Do this at least once a day for several minutes, and make it a permanent part of your exercise activity.
- Anti-inflammatory medications: Can help in reducing pain and inflammation.
- Lateral Band Walks & Extended Leg Twists With Strap: Place both legs between a mini-band and position the band belowyour knees. Take small steps to your right for 20 feet. Then sidestep back to your left for 20 feet.
- Strengthen your hips: Use hip raises, side planks and side-lying hip abduction exercises.
In conclusion, ITBS is painful. But the pain can be short lived – by resting, recovering and modifying your workout routine, you can start to reduce the pain levels. And, by following the seven recommended steps above, you can eliminate the pain.
Listen to your body, honor it and keep it healthy.