ITB Pain: Why it happens & how to fix it
With the London Marathon just around the corner, we are going to release a series of blogs about some common running injuries we see at Ultra Sports Clinic. The first in this series is Illiotibial Band Friction Syndrome (ITBFS).
Lots of people have experienced ITB pain personally, or at least know someone who has. However, the mechanism behind this pathology is quite poorly understood amongst the general population.
Runners with this injury report pain in the outside part of their knee about 2-3cm above the lateral joint line. Individuals report an onset of pain at the same distance or duration of their run. Pain is particularly provoked by downhill running.
The ITB itself is a long piece of connective tissue reinforcing the tensor fascia lata (TFL). It's function, along with the TFL, is to abduct, extend and laterally rotate the hip. Moreover, the ITB contributes to lateral knee stability. Underneath the ITB is bursa, which is a small fluid filled sac that helps to lubricate the joint. Repetitive frictioning causes inflammation and therefore pain in this bursa. Illiotibial band friction syndrome is therefore a bursitis (inflammation of bursa).
Among the general population, there is a lot of variability in the width of the ITB. Therefore, in some cases, people with wider ITB's will be more prone to developing ITBFS for that reason alone. But for most individuals we see at Ultra Sports Clinic, the primary reason for the development of this condition is poor biomechanics.
When a runner's foot first makes contact with the ground, the average amount of knee bend at that exact moment is 21'. The frictioning of the ITB happens at 30' knee flexion which is right before contact. Downhill running increases the duration of time spent in that 30' knee bend position and therefore exposes the ITB to a greater volume of frictioning. While running at a faster pace and on flat surfaces can reduce the risk of developing this condition, it is still possible for runners to experience this pain. If an individual has reduced strength with knee flexion and extension, then they will have a less efficient breaking mechanism. This will predispose someone to developing ITBFS. Moreover, if a runner demonstrates a lack hip abduction control, in particular with eccentric (lengthening under load) control, they have a much higher risk of developing ITBFS.
So while you cannot change the width of your ITB, you can certainly improve the biomechanics around your hip and knee to reduce the frictioning of the ITB on the femoral epicondyle and bursa. This is where physiotherapist guided rehabilitation has an important role in both the management and prevention of ITBFS. If you are beginning to experience pain in the ITB, a physiotherapist can assess the length of your ITB with an Ober's test, as well as strength test the muscles of the hip and knee to determine where any weaknesses may be. From here, a biokineticist can structure a bespoke rehabilitation program which focuses on improving the strength imbalances of the runner.
If an ITB is shown to be shortened, a physiotherapist or sports massage therapist can perform soft tissue release to the tight muscles of the hip and knee, in particular vastus lateralis and tensor fascia lata. Your physiotherapist can also prescribe stretching and foam rolling exercises to improve the length of these muscles. It is worth noting that the ITB itself is a thick piece of connective tissue. As such, massage, dry needling and foam rolling the ITB itself does not change it's length. This has been proven in numerous research papers in the last decade. Any myofascial release to the ITB itself will simply provide some temporary pain inhibition and therefore we do not endorse it being the primary focus of rehabilitation.
In particularly stubborn cases of ITBFS, an ultrasound guided steroid injection directly into the bursa is an effective way of calming the inflammatory response, allowing an individual to rehabilitate their biomechanical deficits more efficiently.
Know somebody with ITBFS? Why not purchase them an Ultra Sports Clinic gift card which can be used with any of the services mentioned above. If you're training for the upcoming London Marathon, don't forget to post a picture tagging #UltraSportsClinic for your chance to win our Marathon Package.
Stay tuned for more marathon tips and tricks in the coming weeks....
Call us today on 0203 893 5100 or book your appointment online.