Iliotibial Band Syndrome in Runners

Pain on the outside of the knee is a common complaint among runners. The iliotibial band is an extension from the tensor fascia lata and glute muscles and tapers down the outside of the leg to the tibia bone. Due to the repetitive nature of running, overloading of the iliotibial band is a common cause of pain on the outside of the knee. 

Cause of IT Band Syndrome in Runners

The iliotibial band transmits force generated at the hip down to the knee. With each stride the glute muscles contract to stabilize the pelvis which transmits force down through the iliotibial band. The prolonged loading on the iliotibial band during running can cause irritation and pain on the outside of the knee where the band attaches to the lower leg. 

The tight IT Band

The iliotibial band is a dense band of fascia located on the outside of the thigh. The consistency is similar to a piece of yarn, as it doesn't have the ability to stretch or contract. This means that the band is always about the same "tightness" and that it is the muscles that create tension in the IT band. 

No study has associated a tight iliotibial band with the development of iliotibial band syndrome
-Current Reviews in Musculoskeletal Medicine

Therefore, trying to stretch or do myofascial release directly on the IT band may not be that beneficial. The amount of force needed to deform the IT band 1% takes about 2040 pounds of pressure. It's no surprise that any amount of stretching, foam rolling, or releasing will create that much force to elongate the iliotibial band. 

Treatment of IT Band Syndrome in Runners 

The treatment of iliotibial band syndrome in runners occurs in two portions. 

The first portion is focused on decreasing the pain. Since iliotibial band syndrome is considered an overload syndrome, it is important to temporarily reduce the load placed on the IT band. This doesn't mean no running at all, but limit the amount of running to allow the IT band to calm down. This can be achieved by decreasing the frequency, duration, or intensity of running. If maintaining cardiovascular endurance is important during this time, swimming or cycling might be activities that can be used instead of running. 

Joint manipulation, soft tissue therapy, and kinesiology taping can all be used to decrease the pain associated with iliotibial band syndrome. Joint manipulation, frequently referred to as an adjustment, can be applied to the lumbar spine or sacroiliac joint to facilitate better movement in the low back and hips. Soft tissue therapy, such as manual therapy or Graston technique, can be used on the quadriceps and gluteal muscles to decrease pain around the knee and thigh. 

The second portion of treatment is focused on strengthening the lower body to reduce the risk of re-injury when returning back to running. The main focus is on increasing the strength of the glute muscles but other regions can be strengthened as well. Glute bridges and clam shell exercises are a useful place to start, the strengthening program should focus on strengthening the glutes and lower body in positions similar to running (like in a single leg stance).