The Band You Don’t Want to Hear
The ilio-tibial band is a skinny little muscle and tendon that runs from your ilium (a bone that makes up one of the wings of your pelvis) over the outside of your hip to the outside of your tibia. Hence the name. It’s called a band because it has a flat ribbon-like shape. It is one of the few muscles that crosses two joints (the hip and the knee) and can cause trouble for runners at both of these joints.
Ilio-tibial band tendinitis is a problem due to friction. When the band rubs over a bony prominence, either at the hip or the knee, it causes irritation and pain that can hobble you during a long run. When on a long run, little things add up. It’s like Chinese water torture–it’s not the first drop of water that drives you mad, it’s the ten thousandth. Similarly, a little rubbing at the knee or hip can really add up over the course of ten thousand strides. It works like this: when your knee is bent or flexed, the IT band lies behind the lateral femoral condyle (the outside bump of your knee). When your knee goes straight or into extension, the IT band snaps over the top of the bump to lie in front of it. And then behind it, and then in front of it…….Rub, rub, rub…….
The same thing can happen at the hip– when the hip is flexed or bent, the IT band is in front of the bump on the side of your hip (the greater trochanter, for those in the know!). When the hip is straightened or extended, the IT band pops over the bump to lie behind the bump. And then in front of it…and then behind it…rub, rub, you get the picture.
It seems the guys get the IT band tendinitis at the knee as they tend to be more bow-legged. When you have legs like a cowboy, the legs bow outward and this puts the IT band under tension. The band then whip-saws across the lateral side of the knee. Gals can get it at the hip as they tend to have a more narrow waist then a wider flare at the pelvis–stretching the IT band over the greater trochanter (you know, the hip bone!).
It seems alot of first time marathoners get this around the 13 mile long run. It could be that 13 miles is just unlucky. Anyway, that’s what happened to me when I trained for my first marathon.
The pain typically starts or intensifies during the run, you can be pain free at the start then it will slowly start to come on. Then, when you stop for a drink and try to start up again–wooop! there it is! Hills seem to make it worse, both up and down. I haven’t seen it in both legs at the same time but there is no reason why it could not happen. Typically, though, it is the left knee or hip. I think this is because most runners run on the left side of the road facing traffic. If the road is crowned, the left leg ends up a bit lower than the right and more stress is put on the IT band on that side. Also, if the lateral heel of the shoe gets too worn down, it allows the foot to roll out a little more and this stretches the outside of the knee a little bit. Repeat 10,000 times and voila… IT band syndrome!
Proper diagnosis is important. IT band is the most common cause of lateral (outside) knee pain in beginning runners but is not the only cause! Also, don’t mess around with any hip pain. It could be a stress fracture with particularly catastrophic consequences if missed. See your friendly neighborhood sports medicine specialist immediately for hip stuff.
To treat IT band tendinitis one must cultivate a patient zen-like attitude. An injured runner is an ugly thing. Runners tend to be type A achievers who want to be fixed yesterday if not sooner. Unfortunately, like all running over-use injuries, this is one of those things that takes several weeks to fix. The first step is to try to identify what is causing it. One little thing wrong, repeated 10,000 times, leads to injury. The trick is to find that one little thing. Is it lateral heel wear? Is it running on a crowned road? Is it hip muscle weakness? Is it just IT band tightness? Is it a combo? (Of course it is, nothing is ever easy in runners!) Correct the shoes. Modify the activity: get on a treadmill, bike, elliptical (just make sure these activities don’t cause it to flare up as well!) Maintain your fitness while you correct the problem.
With any injury, ice and stretching are good ideas. Do this preferably after the workout and make sure to do it long enough so that it has a chance to be effective. I recommend putting on your favorite song and stretching one leg for the duration of that song. Then, put on your second favorite song and stretch the other, second favorite leg for the duration of that song. Then, run cold water over the IT band or ice it. A convenient way to ice it is to take styrofoam cups, fill them with water, and put them in the freezer. Then, when you’re ready to ice, take them out and peel back the rim of the cup to expose the ice. Hold the base of the cup in your hand and voila!–a handy-dandy ice thingie!
There are several stretches described for IT band tendinitis. The “classics” are shown below. I also like one I call the picnic table, where you put the outside of your foot on the top of the table and fold over it. Also, just sitting cross-legged can be a good stretch for some runners, depending on your level of tightness.
In an emergency, like the Olympic trials is in 3 days, the IT band can be injected with a cortisone like substance to eliminate the inflammation. I don’t like to do this as it just treats the symptoms and doesn’t address the root cause of the problem. A better way to deliver medicine to the area is to do iontophoresis (applying a steroid paste to the skin and working it into the tendon and inflamed area with electrical energy). This is done by a physical therapist who can teach you exercises to keep the IT band supple (as well as other muscles!). In my 15 year practice of treating runners, I have only had to operate on the IT band twice, the mainstay of treatment is non-operative.
So, in summary, IT band tendinitis is common, especially in beginning marathoners, can affect the hip or the knee, has recognized causes and risk factors, and is easily treated without surgery. So bring it on, high mileage! We ready for you now!!!!!!!!