Iliotibial band syndrome is the most-common cause of lateral knee pain in endurance runners, and the troublesome condition can account for up to 12 percent of all running injuries.

 

The iliotibial band, a slab of muscle and connective tissue which runs down the outside of the leg from the hip to just below the knee, tends to impinge on a lateral projection of the femur at the knee just after foot strike occurs. Repetitive rubbing of the iliotibial band on the femoral projection can produce a painful, chronic inflammation which we call iliotibial-band syndrome (ITBS). An old-fashioned case of ITBS can set your training back for six weeks or more, putting the damper on your hopes for a PR in a 5K or success in an upcoming marathon.

 

So what steps should you take if you already have ITBS, and how can you prevent ITBS from occurring in the future?

 

When an injury like ITBS occurs, taking anti-inflammatory medications and cutting back on training can ease the pain, but they are not the solution to the problem. A runner who ingests anti-inflammatories, runs fewer miles than usual, and enjoys a relief from ITBS symptoms after a few weeks has not solved his/her difficulties. He/she will be at increased risk of more ITBS trouble in the future.

 

That’s because the appearance of ITBS was not a random event, a lightning bolt out of the blue which struck for no apparent reason. The development of ITB means that the ITB has been too weak to stand up to the training which has been conducted. The real solution, then, is to reduce training on a permanent basis, usually not a very desirable strategy, or to strengthen the ITB. But how in the world can you strengthen the ITB so as to block future injury to the tissue?

 

Human-anatomy texts tell us that the function of the ITB is to abduct the leg at the hip, i. e., to move the leg laterally, away from the midline of the body. This definition strikes many runners as odd, since they can’t recall any workout or race in which they were running by moving their legs to the sides instead of straight forward. If the function of the ITB is to abduct the leg, how does it get hurt during endurance running, an activity which appears to call for no abduction?

 

The answer is that the writers of human-anatomy books are generally not overly concerned about the functions of muscles during running. If they were, they would write that the role of the ITB is to control adduction of the hip during ambling. The ITB works eccentrically to prevent the thigh from moving inward when the foot is on the ground during the stance phase of gait. When it does so, the ITB is stretched out, because some adduction must inevitably occur. The ITB is also active, because it must try to limit adduction. And so the action is eccentric – the poor ITB is trying to contract but is stretched out nonetheless.

 

What about the connection between that rubbing action of the ITB on the femoral projection and this eccentric activity? If the ITB is weak, it permits greater adduction (inward movement of the thigh) during stance. That stretches the ITB, puts it under greater tension, and presses it down on the femoral projection. Weakness of the ITB is thus the key risk factor for ITBS.

 

To reverse this weakness, you can head to the gym and carry out hip-abduction exercises until you are blue in the face, but these hip kidnappings will not strengthen your ITB for running, because concentric hip abductions are not specific to the eccentric, control-of-adduction function of the ITB during running. What we have learned from a couple of decades of scientific research is that strengthening exercises must be specific to a particular movement, in terms of muscle-activation pattern, neural control, joint range of motion, and velocity, in order for that movement to be actually fortified. As many experts have pointed out, the desired goal is to strengthen movements, not individual muscles.

 

Karen Ward comes to our rescue here. The brilliant, creative, Atlanta personal trainer (see her web site at http://www.dynamicfitnessconcepts.com) has developed an excellent exercise for advancing ITB function and strength during running, an exertion which will keep ITBS at bay. Her routine is called Frankenstein Marching with a Band (Karen has a sense of humor, too).

 

The drill is straightforward to carry out. To perform Frankenstein Marching, stand on a stretch band, with the handles of the band in your hands and the middle portion of the band directly under the arches of your feet. Cross the band handles in front of you, so that your left hand is now holding the handle which was in your right hand and your right hand is holding the left’s. This will make an X in front of your legs with the band. Then rotate each arm out to the side, so that your thumbs are pointing laterally.    Retract your shoulders, and keep your feet parallel, shoulder-width apart, pointing straight forward. Walk forward briskly with relatively straight legs while maintaining a standing-tall alignment. Keep your head up and pointed straight forward (don’t look at your feet). Avoid the common mistakes associated with Frankenstein Marching - feet turning out as you move forward, distance between feet too small, head directed downward, and shoulders falling forward.

After a few steps, you’ll begin to feel your ITBs zinging eccentrically, but that zinginess and resulting ITB fatigue will be far better for you than the six-week bout of ITBS which Frankenstein Marching can help prevent. Start with 2 X 15 meters of Frankenstein Marching as part of your warm-up or regular strengthening routine, carry it out a couple of times a week, and progress to 3 X 20 meters with a much-more-resistant stretch band. When you do, you’ll be keeping yourself out of future ITB peril. And while no scientific research has been conducted in this area, the increased control of adduction you’ll gain by strengthening your iliotibial bands should enhance your running economy, an important predictor of running fitness and performance.

 

“Iliotibial Band Syndrome in Runners: Innovations in Treatment,” Sports Medicine, Vol. 35 (5), pp. 451-459, 2005