IT Band Pain – iRunFar

Welcome to a brand new article sequence! This sequence will change into a complete how-to information for self-treating lots of operating’s most complicated aches, pains, and accidents. This first article begins with one of the crucial widespread runner illnesses, iliotibial (IT) band ache, additionally known as IT band syndrome.

I started orthopedic and sports activities medication writing 15 years in the past, when the ink was barely dry on my bodily remedy diploma. My writing motivation was borne from my earliest days of operating, after I craved — and scoured the web for — info that would assist me overcome cussed operating accidents.

My writing objective then was, and nonetheless is as we speak, to supply normal assist and distinctive insights into running-related ache and accidents.

After 15 years of scientific observe, 20-plus of teaching, and almost 30 years of aggressive operating, I lastly really feel comfy sharing my complete methods for overcoming lots of operating’s best damage obstacles.

Joe’s Fix-It Series will goal to alleviate widespread operating accidents and get you again on the street or path. Photo: iRunFar/Eszter Horanyi

How This Series Works

These articles can be constructed equally with the next sections:

• Introduction to the damage
• What the damage is considered, versus what it’s: A key problem to many operating accidents begins with how they’re outlined and understood. We will determine the standard definitions of every subject and we’ll focus on what we predict really creates and perpetuates the particular issues.
• Self-treatment methods: We will determine a sequence of complete, multi-dimensional, self-treatment methods. These methods not solely cowl a number of physique components and kinds of physique tissue, however are additionally structured in the 4 dimensions of complete care and performance to incorporate mobility, energy and stability, run effectivity, and pacing — in that order. The kind and sequencing of this care are vital. To transfer effectively first requires mobility. Strength and stability are then required to maneuver these components with steadiness, effectivity, and energy. Then, can these components — and the entire physique — transfer in an environment friendly approach? We will determine methods for every, making a complete care plan that may get you feeling and transferring higher, quicker!

Disclaimer

All medical recommendation discovered on-line is for instructional functions solely, together with in these articles. It is just not meant to diagnose or deal with yours or every other particular sickness, damage, or dysfunction. All readers ought to seek the advice of with a licensed medical skilled as as to whether or not these approaches are secure and acceptable for his or her particular wants.

Introduction to Iliotibial (IT) Band Pain

Iliotibial (IT) band ache consists of any knee ache that happens on the lateral or outdoors a part of the knee. There are many buildings that may trigger ache on the outer knee (much like the foot). Specifically, the IT band is a large band of very robust fascia that runs from the pelvis to the lateral knee, inserting onto the higher shin. IT band syndrome refers to any ache associated to this fascial construction, or within the area of the lateral hip, thigh, and knee.

Diagram displaying the anatomy of the IT band and the place ache sometimes presents in IT band accidents. Photo: Shutterstock

What IT Band Pain Is Thought to Be

IT band ache, as outlined by WebMD, is “an damage usually attributable to actions the place you bend your knee repeatedly, like operating, biking, mountain climbing, and strolling lengthy distances.”

It is considered an overuse and extra friction downside, continues WebMD: “The downside is friction the place the IT band crosses over your knee. A fluid-filled sac known as a bursa usually helps the IT band glide easily over your knee as you bend and straighten your leg. But in case your IT band is simply too tight, bending your knee creates friction. Your IT band and the bursa can each begin to swell, which ends up in the ache of IT band syndrome.”

How does an IT band get too tight and create extra friction? Per WebMD:

• “Not utilizing the proper coaching strategies
• Not doing sufficient to stretch, heat up, and funky down
• … Go[ing] too far or for too lengthy
• Not resting lengthy sufficient between exercises
• Wearing worn-out sneakers
• Running or coaching on the flawed surfaces
• Running downhill
• Running solely on one aspect of the street. Because roads slope towards the curb, your outdoors foot is decrease, which tilts your hips and throws your physique off.
• Training on banked, slightly than flat, surfaces. Most operating tracks are barely banked.”

Conventional remedy approaches to IT band ache and IT band syndrome, embody:

• Rest and ice
• IT band stretching
• Footwear adjustment
• Training changes: much less quantity, extra warm-up and cool-down

What IT Band Pain Actually Is

Lateral knee ache when operating is usually the results of one or each of the next:

• Excessive lateral influence pressure: Landing in such a approach that the lateral leg absorbs extreme pressure. Either an excessive amount of pressure is being absorbed, usually, or it’s concentrating within the outer leg, notably the knee.
• Excessive torsion and shear forces on the knee joint: Torsion, or rotational stress, and shear, or side-to-side stress, was outlined in our article about knee ache, The Complex Knee.

The knee is designed to do greater than the straightforward hinge movement of bending and straightening. Its environment friendly motion consists of each inner and exterior rotation, with small quantities of side-to-side movement.

When this movement turns into extreme, it causes ache. A healthy IT band has loads of mobility to permit probably a whole bunch of 1000’s of bend-straighten motions in a day. But it solely permits for a small quantity of torsion and shear motion. Excessive torsion and/or shear movement is the issue that causes overt pressure on the IT band. The origin of extreme rotation and shear is generally above and under the knee: on the pelvis and hip, and the foot and ankle.

Thus, the true resolution to IT band or every other lateral knee tissue ache is to appropriate these extra actions by addressing the entire joints surrounding the knee: pelvis, hip, foot, and ankle. Doing so will instantly lower the pressure on the IT band, usually leading to fast enchancment in ache, mobility, and operating tolerance.

Lateral knee ache can rapidly cease a runner of their tracks. Photo: Shutterstock

Step 1: Mobility-Based IT Band Pain Self-Treatment Strategies

The first step in reducing the pressure on the IT band is just not merely to therapeutic massage and stretch the IT band, itself. Rather, we have to restore full movement to all of the components round it: the pelvis, hip, knee, ankle, and foot. The video under offers an outline of the difficulty and its remedy.

Pelvis and Hips Mobility

An excessive amount of the rotational stress on the knee stems from the hip. The hip is meant to rotate loads, in all points of athletic motion, but in addition in strolling and operating. Loss of rotation — or an imbalance of movement the place a hip may internally rotate excessively however be restricted in exterior rotation — is quite common and sometimes refined.

Indeed, a lack of hip exterior rotation usually creates extra inner rotation or medial shearing of the femur, creating an inward pressure on the knee — usually mixed with an exterior rotation pressure created on the ankle.

The pelvis is the muse of the hip complicated. It, too, wants to maneuver, in small-but-crucial quantities. Restrictions in its movement and/or malalignment — anterior pelvic tilt, for instance — can change how the femur bone strikes, inflicting pressure on the knee.

Restoring full hip and pelvic mobility and environment friendly alignment is an important step in any knee-pain remedy, particularly IT band ache.

• Self-massage: Free the pelvis and hip by working the delicate tissues round these bones.
  1. Use a therapeutic massage ball (resembling a tennis, lacrosse, or custom-made therapeutic massage ball) to melt the myofascial tissue across the rim of the pelvis.
  2. Then work the hip joint, the place the thigh meets the pelvis, in all instructions: entrance (hip flexors), outdoors and again (glutes), and inside (adductors).
  3. Pay particular consideration to the tensor fascia lata muscle. This is the muscular a part of the IT band, discovered on the anterior-lateral a part of the pelvis, and is the simplest a part of the IT band complicated to mobilize. Here is a deep-dive on how one can carry out three-dimensional hip self-massage.
• Stretches: Key stretches to revive hip and pelvic mobility embody:
  1. Hurdler stretch, mentioned in our hip abduction/rotation article
  2. Boogie board and aspect lunge, or ninja pose, as seen in our pelvic mobility article
  3. Hip and pelvic roll and attain
  4. Runner’s lunge

Runner’s lunge, again view. Photo: Joe Uhan

Foot and Ankle Mobility

The reverse bookend of the purposeful knee resides on the foot and ankle. The tibia, the underside half of the knee joint and insertion level of the IT band, is the dominant bone of the ankle. Stiffness on the ankle is a significant component in knee ache. If the ankle joint can not correctly dorsiflex, it usually rotates excessively. This exterior rotation can create substantial torsion pressure on the knee, particularly when mixed with femoral inner rotation.

A giant twist can equal massive ache within the IT band and different knee tissues!

• Self-massage: Work all points of the foot and decrease leg. Massage balls are nice to free the tissues of the plantar foot, which incorporates tendons that run the size of the tibia and fibula. Also mobilize the internal and outer shin, and the calf and Achilles complicated, utilizing a foam curler or different therapeutic massage device.

Massage balls are nice to free the tissues of the foot. Photo: iRunFar/Eszter Horanyi

• Stretches: By far a very powerful stretch for the foot and ankle complicated is the belt ankle stretch. This is as a result of the belt applies the requisite pressure to make sure the tibia and fibula correctly transfer into dorsiflexion, with out extreme exterior rotation or side-to-side shearing pressure.

Ribcage Mobility

The thoracic backbone, comprised of thoracic vertebrae and ribs, performs a refined however extremely vital function within the alignment and movement of the hips — and the general alignment of your entire leg, together with the knee. Having good, balanced trunk movement feels good, aids in posture and respiration, and may additionally guarantee effectivity on the knee.

• Self-massage: The best option to carry out fundamental mobility, together with delicate tissue mobilization, is by rolling the ribcage with a foam roll. Perform side-to-side, up-and-down, and arch-over maneuvers to enhance mobility.
• Stretches: My favourite thoracic backbone and ribcage stretch is this method utilizing a remedy ball. This stretch promotes elongation and rotation within the operating sample.

Knee Mobility

Finally, we get to the knee! For most of my shoppers, I obtain 80 to 90% ache decision by way of working all points across the knee, with out working the knee itself. Yet, to place the ending touches on a complete IT band remedy requires some work on the knee joint — however in methods apart from IT band stretching and therapeutic massage alone.

• Self-massage: Massaging the lateral thigh is vital, however not essentially to mobilize the IT band. Evidence-based analysis has proven that the IT band really has little-to-no stretch capability. What it wants as a substitute is to have enhanced mobility, away from the lateral quad. To try this, therapeutic massage the quads three-dimensionally, by pushing them away from the femur bone.
  1. The greatest methods to try this are by working the lateral quad with a ball or foam curler from under, or at a 45-degree angle. This is a option to mobilize the lateral quad and IT band away from its attainable restrictions with the knee, hamstrings, and different adjoining tissues. This is more practical — and much much less painful — than straight rolling it, which solely mashes the IT band and quad tighter into the femur.
  2. Here is an in-depth have a look at how one can successfully mobilize the muscular tissues of the femur, together with the lateral quad and IT band.

• Stretches: Nearly all IT band stretches are a type of hip and pelvis mobility.
  1. To straight deal with the knee, a very good start line is an easy quad stretch. But the knee itself usually wants a particular de-rotation technique, that may reverse the most typical inefficient sample: extreme femoral inner rotation and tibia exterior rotation.
  2. A straightforward-but-potent approach to try this is utilizing the swivel stretch. This is an lively technique that externally rotates the femurs on a steady (comparatively internally rotated) tibia, because the knee passes from flexion to extension.

Step 2. Strength- and Stability-Based IT Band Pain Self-Treatment Strategies

Strength and stability are comparatively much less vital than the restoration of mobility. However, as soon as mobility is restored, energy work is required to take care of that new movement, and stop the entire leg from returning to its earlier, inefficient sample.

Key workouts that work on environment friendly hips, knees, and ankles embody:

• Split squat: This train works on environment friendly hip and pelvis loading. The key side of the cut up squat is twofold: an environment friendly pelvis that’s degree and pointed straight forward.

The creator demonstrates the correct down place of the cut up squat, the posture differentiating it from an everyday squat. Photo: Joe Uhan

• Runner heel increase plus toe-up: This whole-leg train works on a robust foot and ankle plantar flexion, whereas the other foot, knee, and hip flexes upward.
• Plyometrics: Various hopping workouts whereas sustaining environment friendly alignment — hip hinge, frontal airplane knee alignment, and balanced foot loading — promote a balanced and robust floor contact. Just a few easy-but-effective hopping workouts will be discovered on this plyometrics article.

Step 3. Run Efficiency-Based IT Band Pain Self-Treatment Strategies

Efficient operating includes the environment friendly use of the hip, pelvis, knee, foot, and ankle joints. Here are some key effectivity ideas to doublecheck if you end up able to run once more:

• Hip hinge — This posture optimizes using the hip in an environment friendly approach whereas operating.
• Knee out and foot in alignment — This technique ensures the knee is in balanced alignment with out extreme medial or lateral motion within the operating movement.
• Avoid an overstriding, overreaching touchdown — Ensuring your foot and leg land principally under your physique’s middle of mass when you are operating is essential to keep away from extreme braking pressure, and extra power absorption into your knee. A foot-under-body touchdown technique normally corrects for a hyper-lateral foot strike that may transmit extreme power to the lateral knee. Use a vertical hip technique and its upward leg motion to create a extra pure, downward, and environment friendly foot strike.

Lithuania’s Aleksandr Sorokin demonstrates a foot-under-body touchdown on his option to successful the 2023 IAU 24-Hour World Championships. Photo: International Association of Ultrarunners

Step 4. Pacing-Based IT Band Pain Self-Treatment Strategies

By the time most runners restore movement, enhance energy, and improve effectivity, most if not all of their ache is gone. If the lateral knee and IT band tissue continues to be painful, then a gradual return to exercise is required.

Guidelines embody:

• A runner ought to be capable to repetitively squat, step, and hop with minimal or no ache earlier than returning to operating.
• Initial operating must be on flat, principally even, and clean terrain. Avoid terrain that’s both too exhausting or too delicate.
• Avoid hilly operating till one can run on flat, even surfaces, with minimal ache, for 4 to 5 miles.

Conclusion

As we’ll define in future articles, the vast majority of standard approaches to particular operating aches, pains, and accidents fail to look past the ache itself. But as we outlined on this article, a sustainable pain-relief technique requires a complete, multi-dimensional, whole-body strategy. This strategy to IT band ache, additionally known as IT band syndrome, is definitely that, however it’s additionally the simplest at rapidly fixing what for a lot of is a protracted and irritating battle.

Call for Comments

Give it a strive, and share your expertise within the feedback part. And, tell us what different pesky runner issues you want to us to deal with in future articles.