Manage Your ITB Syndrome

A common injury with distance runners is ITB syndrome. This is pain on the lateral or outer side of the knee. It is caused by friction or rubbing of the ilial tibial band (ITB) against the outer tissues and structures of the knee, and you guessed it, it causes a lot of pain when running.

So now what? Often we seek advice from Dr. Google, and yes, some of the advice is OK, some of the time. Endlessly stretching a tissue band that is meant to be tight is not comfortable to say the least, and often not effective for relieving the pain. So what should you do?

The best option is to get a good diagnosis, and that’s not just being told you have ITB syndrome, but actually the reason why you have ITB syndrome. ITB is a mechanical imbalance in the whole lower extremity. Foot, knee, hip and pelvis mechanics can all play a part. Not mention the likely muscle imbalances that can precede and/or cause this injury.

So if your health professional just rubs your leg and tells you to roll on a golf ball or foam roller, ask for more. You need a full diagnosis of why you are getting the knee pain, and a good plan to solve it.

As an example, in clinical practice I find that one common cause of persistent ITB syndrome is a pelvic imbalance. A twist in the pelvis can make the stride length slightly reduced on one side, resulting in a muscle length imbalance in the upper leg and pelvis and overload of the joints in the opposite leg.  Some of  these muscles then end up working too hard, tighten up, generate pain and friction and then fatigue causing further biomechanical stress in all of the leg structures.

Another one as a runner you would have heard of is Patella tracking issues, or runners knee.  This is a weakness of the middle lower thigh muscle (vastus medialis oblique or VMO)  causing your knee cap to not glide in its correct alignment. Over time this causes pressure and pain in the knee, and if untreated you would get a shorter lateral thigh muscle and tighter ITB. The end result for you is generally knee pain, especially with loading, which means all running and weightbearing exercise, particularly on the hills.

I can’t stress enough that to fix your knee problems you need to get a good diagnosis. Stretching at home can help some people some of the time but, always seek out a good diagnosis that comes with a treatment and management plan.  And if things are not changing as quickly as you need, get another opinion.

Don’t spend months not training due to ITB syndrome- it is a very manageable injury.