18 May IT Band Syndrome…ITB Tendonitis
IT Band Friction Syndrome plagues many runners and cyclists with what can be debilitating lateral knee pain. This is an overuse injury that results in inflammation of the IT Band due to repetitive flexing and extending of the knee and often occurs when there is an increase in weekly mileage. Basically what happens is the lower part of the IT Band rubs over the end of the femur when it switches from being in front of the knee (when the knee is extended) to behind the knee (when it’s flexed). Combined with excessive running, if the band is taught, the inflammation will likely escalate.
So what do you do about it?? This can be a nagging injury if not dealt with in a timely fashion. First and foremost, do not try to “run through” this pain. You want to immediately decrease the inflammation with all the usual tricks – ie: Ice, anti-inflammatories, and unfortunately activity modification (limit running/biking). Next, figure out why it happened in the first place. As stated before, often times it can be due to a sudden increase in mileage. Other factors to consider are: footwear, leg length discrepancies, muscular imbalances (generally overactive Tensor Fascia Latae (TFL) and decreased activation of the gluteus medius), decreased flexibility or joint mobility, and the list goes on.
To address the tightness of the ITB, a common technique is foam rolling. Lately there has been contraindicating advise regarding this topic, however in my personal experience I have found it useful for many patients, therefore continue to recommend its use. The ITB is a band of connective tissue that originates from a muscle on the outside of the hip, the TFL, and inserts just below the knee joint. I prescribe foam rolling the fascia between the ITB and the quadriceps (diagonally on the thigh) as well as over the TFL for about 5-10 minutes a day. The goal here is to increase blood flow and remodel any connective tissue restrictions that may limit mobility and flexibility.
Muscular imbalances and leg length discrepancies can be identified by your Physical Therapist. They should also look at other biomechanical factors such as hip mobility and arch control of the foot. Once you have calmed the initial inflammation down and begin to correct contributing factors you can initiate running/cycling again monitoring for symptoms to prevent recurrence.