IT Band Syndrome: Treatment and Prevention
by Steve Elton
Often an athlete trains to perfection only to be stopped in their tracks by stinging pain on the outside of the knee. Ice and medicines can't stop it, and frustration grows as training degrades. This all too familiar problem that runners, cyclists and triathletes face is caused by tightness in the Iliotibial band, commonly referred to as the ITB. The correct term for this malady is Iliotibial band friction syndrome or ITBFS.
The ITB is a broad band of connective tissue that spans the hip and the knee joints. As it tightens during movement, this structure rubs against the outside of the femur causing inflammation and pain. So, how does one approach the treatment of ITBFS? The first part is finding out the cause.
There are many predisposing factors to ITBFS, which can include but are not limited to: training errors, improper foot wear, hyper-pronation, muscle imbalances and a lack of flexibility. The sports medicine clinician must address any and all issues, and perform a thorough exam to set up a treatment protocol. In my experience, ITBFS is most accurately treated by addressing strength and flexibility imbalances. Once the cause is known, and any training errors are eliminated, a treatment plan can be implemented.
The primary reason for the muscle imbalance that leads to ITBFS is actually simple. The gluteus medius, the primary hip stabilizer during gait, is located on the outside of the buttocks. This muscle is constantly firing to keep the pelvis level during running. Now, the hip joint needs to keep a constant amount of force across itself to maintain stability. When the gluteus medius fatigues, other muscle contract around the hip joint to maintain or take over its stabilizing role. The problem is that these muscles are not designed for this job! This results in altered gait and biomechanics of the hip and the result is a tight ITB.
So, what can an athlete do to alleviate the pain, or prevent ITBFS? The main focus of this rehab and prevention should be increasing the elasticity of the ITB and restoring the strength to the gluteus medius muscle. Stretching is usually prescribed, but in my opinion the ITB, as well as the deep lateral rotators of the hip, should be loosened up by deep tissue massage. After a few sessions of deep tissue work, stretching can be started to help maintain the flexibility gained in the tissues from deep tissue work. Deep tissue massage is not comfortable, but does reap great results and accelerates treatment.
Strengthening the gluteus medius can easily be accomplished by 3 simple exercises. Number one is side lying leg raise. Lie on the opposite side with a #5 ankle weight attached to the leg. Lift your leg 12 inches and hold for 5 seconds. Repeat until the leg fatigues, and perform 2-3 sets. Number two is the monster walk. A theraband, or similar elastic resistance band, should be used. Simply make a loop and step into it with the material around the forefoot of both feet. Never allow the band to slacken and slowly walk sideways controlling the speed of the trailing leg-- don't let the foot of the trailing leg drag on the floor! Perform 10-20 steps in each direction and do 2-3 sets. If this is not difficult, either the theraband is not tight enough or you are not performing the exercise slowly enough.
Lastly, an exercise called “Kicks” is a great functional exercise to strengthen the gluteus medius. It also is great for increasing the flexibility of the groin muscles on the opposite side of the hip joint. To perform this exercise simply stand sideways at arms lengths away from a wall. Use your hand to stabilize yourself on the wall and lift the opposite leg parallel to the floor with the knee bent at 90 degrees. At a moderate tempo, alternately extend and flex your knee 10 times while keeping your leg parallel to the floor. Perform 2-3 sets for each leg. Ultimately, you should be able to do 3 sets of 20 each leg. Some athletes have difficulty keeping the leg parallel to the floor at first. This is okay; as your strength and flexibility improve you will be able to perform this exercise correctly.
This is certainly not an all-inclusive list in the rehabilitation of ITBFS. Many healthcare professionals may choose other options in addition to what I have listed above. But, these recommendations are, in most cases, excellent to tools to solving and preventing the problem.
Steve Elton is a physical therapist, strength and conditioning specialist and triathlete. He received his MS from the
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