Banish IT Band Pain

Iliotibial Band Syndrome (a.k.a. ITBS or IT band pain) is one of the most common running injuries.  The pain is debilitating, often stopping you dead in your tracks and forcing a long layoff from running. We’ll examine the cause of IT band pain, why commonly prescribed treatments are ineffective and the one exercise that you should do to alleviate this painful injury and get you back on the roads.

Sarah, one of the runners that I recently coached, had been suffering from IT band pain, which was preventing her from doing any running.  To alleviate the pain, she had purchased an over the counter knee strap to be worn while running.  In addition, her physical therapist had prescribed a heel lift to correct a minor leg length discrepancy.  Her ITB symptoms decreased in severity, but two weeks later, she began experiencing knee pain in the same leg.   When she attempted to increase her mileage, her IT band pain returned with a vengeance!

Understandably frustrated, she asked me if I thought that her new knee pain was somehow related to her ITB treatment and why her IT band pain had returned.

To quote the old gospel song, “Dry Bones”:

Your foot bone connected to your ankle bone

Your ankle bone connected to your leg bone

Your leg bone connected to your knee bone

Your knee bone connected to your thigh bone……..

Those in the health and fitness profession may prefer to state the same sentiment by describing the body as a kinetic chain.  Modifying one link of the kinetic chain (i.e. body part) will have ramifications on other related parts of the body.  In Sarah’s situation, the knee strap and heel lift initially helped her ITB pain symptoms but appear to have caused her new knee pain.  Most importantly, the knee strap and heel lift did not address the cause of her ITB pain, which is poor running-specific strength – thereby explaining the resurgence of her ITBS.

The best explanation of the cause of IT band pain comes from Owen Anderson, Ph.D., is a leading exercise physiologist and researcher in training, sports nutrition and injury prevention. We apologize in advance for the very technical explanation that follows.  If you don’t feel like reading it, just skip two paragraphs to the one sentence summary in bold blue print.

Dr. Anderson: “The ITB works eccentrically (attempts to contract while increasing in length) 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 (inward movement of the thigh) 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 ITB Syndrome” (The bracketed sections are our explanatory notes).

Conventional treatment of ITBS consists of stretching exercises and performing hip abduction strengthening exercises, either on a hip machine or lying prone and using ankle weights.  I know from first-hand experience that neither is effective in eliminating ITB pain.  I suffered through four years of ITBS before I started performing ITB strengthening exercises for eccentric movement (i.e. running-specific).

Dr. Anderson: “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.”

So, what exercise can you perform to develop running-specific ITB strength and thus eliminate or prevent ITBS?  The “Frankenstein Marching with a Band” exercise, developed Karen Ward, an excellent and creative personal trainer in Atlanta.   What equipment is required? Only a stretch band.

Dr. Anderson: “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 lefts. 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 (yards) 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.”

© 2010 Savvy Runner Inc.

 We welcome your feedback, suggestions and comments.  Please post them below.

IF YOU WOULD LIKE TO USE THIS ARTICLE IN YOUR EZINE, BLOG, WEBSITE OR PUBLICATION, you can – as long as you include: “Bennett Cohen (The Savvy Runner) and Gail Gould are the Founders and Presidents of the International Association of Women Runners.  To learn more about this global community of women runners, visit www.iawr-connect.com.