The Iliotibial band (IT band) is a thick band of tissue that extends from the thigh, down over the knee and attaches to the tibia. When the knee bends (flexion) and straightens (extension), the IT band slides over the bony parts of the outer knee. The term IT band friction syndrome (ITBFS) refers specifically to a syndrome of lateral (outer side) knee pain related to irritation and inflammation of the bottom portion of the IT band.
As you run, flexion takes place at the hip and at the knee. The IT band passes over the outside of the knee and friction is produced. During weight bearing activities such as running and walking, compression and friction forces increase and pain occurs. Also during weight bearing, there is a contraction of the surrounding muscles which tightens the knee joint. This leads to more friction over the outside of the knee as the IT band crosses it and pain is increased. If forces are increased the area will become intensely inflamed and IT band friction syndrome is produced.
The average jogger makes 3,000 foot strikes per mile. That is 15,000 foot impacts for every five miles. Each leg impact must bear the entire body weight by itself-because in running you only have one foot on the ground at a time. In walking, 30 percent of the time, both feet are on the ground. The force of landing is about three times your weight. that means that if you weigh 75kg, the force when you land is around 225kg. Shoe mileage should also be considered. After 500 miles most shoes retain less than 60% of their initial shock absorption capacity.
In runners with normal feet, the force of running is dissipated by the foot. However, if you have a minor abnormality in your foot setup, like high or low arches, the force of the foot strike is passed to the knee area. Biomechanical abnormalities associated with the IT band syndrome such as supination in the foot (rolling out when you foot strike) suggest that the stress about the knee will increase and possibly will cause more IT band friction. Common predisposing factors include:
- Footwear - excessively worn on the lateral heel and outside of the shoe
- The wrong shoe – 9 times out of 10 an individual with runners knee are wearing a support shoe
- Leg length difference
- Runners with overpronation leading to increased internal rotation of the knee and increased tension to the outside of the leg.
- Running on Roads with a camber (side slope)
- Muscle Imbalance
- Foot dysfunction
- Low Back Issues
So What Can You Do?
Firstly, and most importantly the cause of the problem must be addressed. In this case running posture or footwear is probably the primary cause. However, it would be worthwhile consulting with a therapist who specialises in gait analysis and injury rehabilitation to ascertain the exact causes.
To get the best advice, a full Running Gait Analysis looking at footstrike, running technique, flexibility and footwear would be of great benefit. This would identify training faults, poor technique, inflexibility and how functional and supportive your running shoes are.
It maybe a case that the needs between the left and right feet are significantly different, if this is the true then several changes may need to be made:
- To stabilise the foot and running posture it may be advisable to have a custom orthotic made to help to support the feet, legs and pelvis and prevent the stresses of imbalance, weakness and tightness. Custom orthotic can be of great benefit not just for injury rehabilitation but for prevention and performance as well.
- Assessment of the pelvis and lower back to address any flexibility and strength Issues that may be the cause of this asymmetry.
Secondly comes
The Self-Help Guide. There are a lot of things that can be done that will help to decrease the amount of muscular tension that would contribute to the problems at the knee.
Flexibility: It is very important for the body to have the same muscle length and tension on the left and right sides of the body as well as to the front and back. If there is a flexibility imbalance in any of those combinations then a problem may arise and contribute to further injury. In this case it is essential that you stretch the tigher areas before you do any strength training.
Stretching is the best thing that you can do immediately (especially of the buttocks, IT band and Quadriceps.)
Self Help Action
- Rest and Ice – icing will decrease the amount of inflammation present. This will help to settle the problem and decrease the pain
- Stabilise the foot with well-fitted shoes
- Consider Custom Orthotics (Fitted by specialists) buying an off the shelf product may not address the imbalances as these come as the same prescription left and right
- Avoid running on cambered roads
- Run on a variety of soft surfaces
- Avoid running down hill
- Stretching
- Carry out some strength work
- Consider changing discipline for a period of time by cross training with other sports. If you cycle, reduce the duration and cycle at a higher cadence with a lower resistance. Try swimming, or even deep water running with the aid of an aqua-jogger belt
If you are in doubt about what to do, consult with a specialist in your area or email alex@drummondclinic.co.uk to get more information.