Education
Tips to Reduce the Risk of Iliotibial Band Syndrome
by Jason Brumitt, MSPT, SCS, ATC/R, CSCS,*D
Includes background on the IT band syndrome and exercises
that can be used to reduce its risk of injury. From the NSCA's Performance
Training Journal.
Iliotibial Band Syndrome (ITBS) is an overuse injury experienced primarily by
distance runners but may be experienced by a wide variety of individuals and
other athletes (e.g., cyclists, hikers). The primary symptom associated with
ITBS is lateral knee pain. Initial symptoms may be minor, with one experiencing
pain at some point during their physical activity.
As the condition worsens, pain may prevent the individual from training and
may even be present when at rest. Assessing one’s risk factors may help reduce
their risk of experiencing this type of injury.
What is ITBS?
The iliotibial band (ITB) is a tendon-like structure (a thickening of fascia)
that extends from the thigh’s tensor fascia latae muscle and extends distally to
attach to the lateral (outside) portions of the knee and tibia.
Recent studies suggest that nerve innervated soft tissue is compressed
between the ITB and the lateral (outside) portion of the femur (2). Instead of
an anterior-posterior slide creating friction leading to ITBS (also called
Iliotibial Band Friction Syndrome based on this assumption), recent studies
propose that pain is due to the compression of the fat and soft tissue between
the ITB and the femur (2).
What Can Be Done to Reduce Injury Risk?
ITBS may be caused by extrinsic and/or intrinsic risk factors. Extrinsic
factors that may contribute to the onset of ITBS include poor or worn-out
footwear, increasing training distances too quickly, running too many miles in
general, and downhill running (1,3,4). Intrinsic risk factors for ITBS include
poor mechanics when running, weakness in the hip abductors, muscular imbalance
around the hips, and muscular tightness in the legs (3,5,6).
Distance runners may benefit from a having a coach or sports medicine
professional perform a running evaluation. Video analysis of one’s running
technique may highlight faulty mechanics. In addition, distance runners should
purchase new running shoes frequently, generally after 300 to 500 miles of use.
With a wide array of shoes on the market it is helpful to seek recommendations
from a podiatrist, sports medicine professional, or from a specialty shoe
store.
Exercise
Simple exercises requiring minimal equipment may help improve strength about
the hips and reduce the risk of developing ITBS. The hip abductors (especially
gluteus medius) have often been identified as dysfunctional in individuals
diagnosed with ITBS (3). The gluteus medius muscle helps to maintain stability
of the pelvis when running. Weakness in the hip abductors will allow increased
hip adduction and knee internal rotation, factors that may contribute to the
onset of ITBS (5).
The side lying straight-leg raise exercise will effectively train the gluteus
medius muscle. To perform this exercise one will lie on their side and raise the
top leg in a controlled movement, focusing on keeping the leg straight.
When performing the exercise, make sure that one feels muscular activation in
the posterior-lateral hip versus the front of the hip. If performed incorrectly,
one will often feel muscle activation of the anteriorly positioned tensor fascia
latae or hip flexor muscles. In addition, when performed incorrectly, the leg
will deviate anteriorly during the lifting motion. Perform two sets of 15
repetitions of this exercise two to three days a week to improve strength of the
gluteus medius.
In addition in the side lying straight-leg raise exercise, one may benefit
from performing an ITB stretch. In a standing position, cross one leg behind the
other extending the arms overhead with the fingers interlocked. To perform the
stretch, lean to the side opposite of the rear leg (i.e., if the right leg is
crossed behind the left, the upper extremities should lean toward the left) (3).
Perform two to three repetitions of this stretch (holding each stretch for 30
seconds).
This stretch can be performed before or after physical activity.
By utilizing both the side lying straight-leg raise exercise and the ITB
stretch, one can help prevent the occurrence of ITBS and reduce the risk of
potential injuries.
References
- Beals, RK. The iliotibial tract: A review.
Curr Orthop Pract 20(1): 87–91, 2009.
- Fairclough, J, Hayashi, K, Toumi, H, Lyons,
K, Bydder, G, Phillips, N, Best, TM, and Benjamin, M. The functional anatomy of
the iliotibial band during flexion and extension of the knee: Implications for
understanding iliotibial band syndrome. J Anat. 208: 309–316, 2006.
- Fredericson, M, and Wolf, C. Iliotibial band
syndrome in runners: Innovations in treatment. Sports Med 35(5): 451–459,
2005.
- Messier, SP, Legault, C, Schoenlank, CR,
Newman, JJ, Martin, DF, and Devita, P. Risk factors and mechanisms of knee
injury in runners. Med Sci Sports Exerc 40(11): 1873–1879, 2008.
- Noehren, B, Davis, I, and Hamill, J.
Prospective study of the biomechanical factors associated with iliotibial band
syndrome. Clin Biomech 22: 951–956, 2007.
- Strakowski, JA, and Jamil, T. Management of
common running injuries. Phys Med Rehabil Clin N Am 17: 537–552,
2006.
This article is from NSCA's Performance Training Journal 10.3. Gain
access to more journal articles with an NSCA Membership.
About the Author
Jason Brumitt is an assistant professor of physical therapy at Pacific
University (Oregon). He is currently a doctoral candidate with Rocky Mountain
University of Health Professions.
