Iliotibial band syndrome (ITBS) is one of the most common injuries among runners. I experienced this injury after my first marathon. No pain during the race, but as soon as I crossed the finish line, I felt pain on the outer area of my knee. A few hours later, even bending or straightening my leg was incredibly painful. Let’s take a look at the origin of this injury and how to treat it.
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What is Iliotibial Band Syndrome?
To produce movement, muscles contract, and they are attached to bones via tendons.
In the thigh, the iliotibial band connects to the tensor fascia latae muscle (TFL) and the gluteus maximus muscle. At the other end, this tendon inserts into the upper tibia. The iliotibial band passes over the outer side of the knee.
Iliotibial band syndrome occurs when the iliotibial band rubs against the lateral epicondyle of the femur. This means a friction between the tendon and a bony prominence of the femur during each flexion and extension of the knee.
The causes can vary: improper running form, inadequate shoes, a sudden increase in mileage, or running long distances or routes with too much elevation… At the first sign of warning, it’s ideal to stop to limit the tendon’s inflammation.
In my case, I ran the marathon in lightweight shoes I usually used for racing: the Asics DS Racer. They have slight pronation control, although my stride is neutral.
These two factors combined – long distance and less-than-ideal shoes – led to this iliotibial band syndrome. Unless you have a specific pathology, it’s better to choose shoe models that do not alter your running biomechanics.
How to Treat Iliotibial Band Syndrome or ITBS?
At the first signs of pain, I encourage you to consult a sports doctor or physiotherapist to get a medical opinion. Personally, I visit an osteopath as soon as I feel pain. This time, he noticed that my ankle was blocked. Even though the injury is in the knee, the cause of iliotibial band syndrome can come from another joint like the ankle or pelvis, as the entire muscular chain is interconnected.
If you frequently experience TFL pain, you may also want to see a podiatrist for custom insoles, especially if you overpronate (foot rolls inward) or supinate (foot rolls outward). It’s also better to avoid shoes with too much drop (the difference in height between the heel and the front of the foot).
Alternating with Another Sport
During this phase of pain, the most important thing is to focus on the three pillars of recovery: staying well-hydrated, eating healthily, and getting good sleep.
You can continue doing physical activities that don’t cause you pain, like swimming or cycling (for some). There is no risk of tendon rupture, and doctors don’t always recommend total rest for iliotibial band syndrome. Healthcare professionals at the Clinique du Coureur recommend maintaining intensity work in running, such as interval training sessions, even if it means walking during recovery periods and reducing overall volume.
You can replace running with another sport to maintain your basic endurance.
Cold Therapy
Apply ice to the tendon for 10 minutes, 2 to 3 times a day to reduce inflammation. Ice is very beneficial. A handy tip is to use a frozen bag of peas to cover the entire outer area of the knee. Of course, do not consume the peas afterwards if you have frozen and thawed the bag several times. When I had iliotibial band syndrome, I tried Pressurice, a refrigerated compression bandage, and found it very practical!
Stretching and Strengthening
Stretching to loosen the gluteal muscles and the tensor fascia lata (TFL) and iliotibial band can speed up recovery. Gluteal strengthening is also recommended.
Good luck during these tough times! With these few tips, recovery should be quicker. When you resume running, start with 30-minute easy runs on flat and even surfaces and gradually increase the duration. You can restart with a personalized training plan with your digital coach, RunMotion Coach.