Injury Archives: Ilio-tibial band
Note: This information is advice given from one runner to another,
and not meant to be taken as a medical consultation. Your best strategy
in diagnosing and treating any injury is to see a doctor who wants
to get you back out there running. He or she will keep trying various
treatments until something works. When that type of doctor tells
you that you need to stop running for a while (because it is a stress
fracture, etc), you should do just that. Ask the most experienced
runners in your area for the names of medical specialists in the
area of your injury, who've helped other runners heal quickly. When
a doctor barely listens to you, and quickly tells you to stop running,
it's time for a second opinion. Sometimes even the best doctors
miss something. There are times when you should talk to 2-3 highly
recommended specialists to get the whole picture.
The Good News
Almost all of the runners I've communicated with about I-T Band
injuries have been able to run during the recovery period, once
the healing had started. Many of these folks have continued their
marathon training program, after making the adjustments for the
injury. Once you've determined that the healing has begun, and your
training stays below the threshold that could further irritate the
injury, you'll probably be able to continue your running. The first
priority, however, is being conservative enough (with slower pacing,
more walk breaks, and days off from running) to allow the healing
Where does it hurt?
Almost always on the outside of the leg, from the knee to the hip.
The pain from I-T band is most often felt on the outside of the
knee, slightly below the intersection of the two leg bones. For
some, pain may be centered just above that point. In rare cases
it may hurt on the outside just below the hip, and occasionally
the pain may radiate up and down the outside of the leg, at various
times. We will concentrate on the most common site, the outside
of the knee.
What gets injured
A strong muscle just below the hip, the tensor fascia, is connected
by a long band of connective tissue that acts as a tendon, going
down the outside of the leg, and connecting to the shin bone below
the outside ot the knee. Even when the wobbling proceeds for some
time, this band of tendon tries to keep the leg from excess motion.
Once the tendon itself loses its strength, and continues to be pushed
beyond it's capacity it gives way at the point of most stress. This
is most commonly where the tendon connects below the knee. A bursa
sac, which tries to smooth out the operation of the knee and protect
the tendon from the bone, may also become irritated. Some runners
strain the tendon itself, others pull away the connections below
the knee, the tendon and the bones. A second area of irritation
is that just above the knee, due to the friction of the tendon repeatedly
rubbing the bone slightly above the knee joint on the outside.
Can I run my marathon, this season?
Maybe. If you back off soon enough, it's possible to run enough
to do the marathon, while it gets better. You will have to reduce
the speed of every running segment and put more walking into your
runs, more often. The longer you continue to irritate the injury,
the longer it will last. Even after you start back, you must monitor
the injury for the next few months. Even after the pain goes away
from an injured area, there is still damage inside. One run that
is done too fast (or without enough walk breaks) can bring back
the damage, often worse than it was before.
How does it get injured? As long as the leg muscles are resilient,
and you're not doing very much more training than you've done in
the recent past, the leg system will stay in its track and adapt
to slight increases. When you push your main running muscles too
far, the primary running muscles get too tired to move you ahead
and stay within the natural range of your foot and leg. In other
words, your legs start to wobble. The further you go when wobbling,
the more you will injure the area. You may not be able to pinpoint
what caused the problem, but here are the most common causes.
- Running too fast, on a long run, or race, than you should have
on that day ( i.e., trying to stay up with running friends that
are going too fast for you). Most runners are running too fast
on long runs, even though they feel fine at the beginning.
- Not slowing down the pace, from the beginning of a long run
or race: when you increase the distance of the long run when it's
hot and humid, or the course is hilly when your muscles are already
tired when you feel the first signs of irritation of what could
be an injury
- Not taking walk breaks, as you need them, from the beginning
of all long runs Not increasing the frequency of the walk break
as the long run distance increases Not increasing the frequency
of walk breaks when you're more tired, or feel the symptoms of
injury Not increasing the frequency of walk breaks when the temperature
and humidity are high
- Doing too many of the following within a 2-3 week period: long
runs, races, fast runs. … Wearing the wrong pair of shoes or ones
that are too worn out‹particularly in the midsole (a shoe expert
can help you determine).
- Doing side-to-side sports: tennis, basketball, rollerblade
- Not doing the maintenance training during the week, i.e., just
running once between long runs, or not at all.
- Skipping a long run and trying to keep up with your group on
the next long run
- Not taking enough days off from running‹especially after the
first signs of injury
- Running on a surface that is too soft or is slanted, i.e. a
beach, soft grass, or a paved surface with a slant.
Treatment I've spoken with hundreds of runners who've run through
I-T band injury. You want to get permission from your doctor to
do this. the healing needs to have started, and you must stay below
the threshold of irritation. In other words, you need to keep from
further injuring the area. If running 4 miles leaves it feeling
worse the next day, run no more than 2-3 miles, every other day.
If it stays injured when walking 1 minute after 3 minutes of running,
then run 1-2 minutes and walk 2-3 minutes. It never hurts to be
more conservative in your running when injured. By running too much
you'll prolong the duration of the injury. Most of the time, you
don't realize what is too much until you've injured yourself. That's
why it's always better to back off at the first hint
1. Take enough time off to get the healing started (usually 3-5
2. Take vitamin C. When I have an injury such as I-T band, I take
1000mg of Vitamin C, 3-5 times a day. Consult with a sports nutritionist
for further information about vitamin C and other nutrients which
can speed healing.
3. Stretch the tendon. The I-T band is one of few running injuries
that is helped by stretching. Start with the stretches recommended
below [note: I want to get permission from Bob Anderson to use some
of his drawings as illustrations]and experiment to find ones that
reduce or eliminate the pain. You can stretch before, after, and
during a run‹and even in the evening, or while sitting at your desk
at work. Stretching primarily reduces the tension on the tendon
so that it doesn't hurt for a while. By keeping the I-T band flexible
you also reduce the continued pulling on it, and may help it to
heal to some extent. Experiment with different stretches for the
area. The best ones are those that release the I-T band at that
time, giving you instant relief. Compare stretches with other I-T
band sufferers, but very few runners will use the same stretch routine.
You will find that different stretches help at different times,
even on the same run.
4. Ice massage. Freeze a paper cup and every night, rub the ice
directly on the area of pain until it gets numb (usually about 15
minutes). Be advised that there's usually no healing effect from
ice in a plastic bag, towel or frozen gel pac. It helps to ice the
injury immediately after a run, but even if you miss this opportunity,
ice it well at least once a day.
5. Run on level surface. Uneven surfaces will fatigue the muscles
and tendons and increase the chance of I-T band irritation. A road
that is slanted can cause I-T band problems on one run.
6. Get the right shoe and possibly an orthotic. Even the perfect
shoe (whatever that is) will lose support from the midsole, usually
without any outward sign on the shoes. To run on these shoes usually
aggravates the injury. Shoe experts, (such as the ones in really
good running stores) can advise you in finding current shoes which
can give the support or cushion your foot needs. Overpronated floppy
feet show some shoe wear on the inside of the forefoot and benefit
from motion control shoes. You'll have to give them feedback how
the shoes feel and whether there are any discomfort areas. The shoe
should be an extension of your foot without any extraordinary pressure
- Floppy feet which overpronate (showing shoe wear on the inside
of the forefoot) need motion control shoes that sacrifice some
cushion for stability. This type of foot can sometimes benefit
from an orthotic. Try stable shoes first and if they don't control
the pronation by themselves, follow your doctor's advice and try
other solutions before getting an orthotic. Remember, if you don't
have a shoe that controls you enough, the foot device won't be
able to do its work.
- Rigid feet (which show wear on the outside of the forefoot)
need shoes with cushion and flexibility. If the shock is not absorbed
by the flex of the foot and the cushion of the shoe, the I-T tendon
will take more abuse, tighten up, and increase the intensity of
7. Massage. Cross friction massage may speed up the healing. Consult
with a running massage expert and you can learn this simple technique.
Massage to other muscle areas may also speed up the healing process.
8. As a last resortŠ.Under doctor's direction: anti-inflammatory
medication and/or cortisteroid injection (i.e. cortisone) may get
the healing started. Get several opinions before you agree to this,
and go to the most experienced and competent doctor you can find.
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