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Tuesday, December 31, 2013

Like a Hammer to the Knee: IT Band Injury and Prevention for Runners.

This summer, based on MRI evidence, my sports physician announced the diagnosis of  "severe IT Band damage" and since then I have drastically changed my methods of training.  I constantly hear of others that have been sidelined with the same devastating injury, and I want to document my experience here so as to help prevent it for everyone else.  I must preface this post by stating that I am not a physician; if you suspect any type of injury it is imperative that you visit a licensed sports physician for proper diagnosis and treatment. 

Image courtesy of

What is it: The Illiotibial Band is a ligament that stretches down the side of the leg, from the hip/pelvis to the shin, and functions to stabilize the knee.  Injury to this anatomy presents with sharp pain in the outer knee during exercise.  For me, I could run almost exactly one mile before feeling like someone struck my knee with a hammer.  I'd set out feeling hopeful that I was on the mend, and then BAM!  Debilitating.  I always had to stop and walk home, battling tears from both the physical pain and the frustration of not being able to run normally.  Illiotibial Band Syndrome (ITBS) is an extremely common overuse injury in runners, and recovery can vary from a few days to several weeks, as in my case.  During this summer while I was in treatment, I was forced to skip FOUR races including two full marathons, a 50k and a 50 mile race.  As any runner can understand, this was completely heartbreaking. 

Causes: Causes for such an injury can include overuse, improper foot strike, running in shoes that need replacing, an imbalance of or weak leg and hip muscles, pronation, running repeatedly on banked surfaces, increasing base mileage too quickly, and tightness in the IT Band itself.  In my experience this summer, I became lazy and complacent in my training.  I neglected cross-training, was sporadic with my foam-rolling routine, and did not, I repeat, DID NOT rest enough.  From this experience, I learned the hard way that rest days are just as important as speed work, long-runs, and proper nutrition.  Do not make the same mistakes that I did, because this injury is so common, it WILL happen to you if proper techniques are not enforced.

Check your shoe wear pattern for signs of pronation and seek assistance from a decent running store for shoe and insole advice!
Image courtesy of the
Prevention: Prevention of injury then obviously includes decreasing mileage (yeah right!) while increasing more rest days, improving running form, replacing worn-out shoes, considering the use of custom shoe insoles, cross-training to increase leg and core muscle strength, following the 10% per week mileage increase rule, varying your running route, and incorporating proper warm-up and stretching into a running regimen.

Diagnosis and Treatment: After weeks of inability to run and consequent impending depression, I hung my head, picked up the phone and made an appointment with a sports physician.  Best decision of my life.  My MD immediately got me in to complete an MRI and the next day he showed me the shaded areas of "severe IT Band damage" on the pictures of my knee reflected on his light box.  From there, I made an appointment with a physical therapist.  I chose one that was familiar with running injuries and he proved to be a priceless wealth of knowledge I will forever utilize.  I met with him weekly for exactly a month. At each session he painfully massaged the area where the IT Band connects with the knee, and taught me several exercises and stretches to improve the strength and range-of-motion of my quadriceps, hamstrings, and muscles of my hips.  In the meantime, I completely stopped running (nearly an impossible feat, but nevertheless necessary in my case), continued to ice/heat my area of damage, continued to foam-roll until it hurt, and began swimming laps to maintain my fitness level as best as I could.  There is nothing more humbling for a runner than to be sidelined with an injury that could have easily been prevented by proactive steps.

Do this now: Since the LAST thing I want to do is reinjure my ITB, and I refuse to decrease my mileage (and I imagine you agree), I have committed myself to performing the following list daily. 

1. Do not neglect rest days, especially after long run days.  Listen to your body; learn to discern feeling lazy versus feeling tired and in need of rest.  And similarly, ensure you are getting enough sleep at night since sleep is how your body repairs after the physical destruction of cells during training.

2. Foam roll.  Do it.  Every single day.  It will hurt, but that is key to improve circulation and blood flow to vital areas to thus promote tissue repair.  If you do not know what foam-rolling is or how it's done, check here. That link also includes pictures of several foam-rolling techniques for the IT Band as well as other main muscle groups.

3. If not already currently doing so, add at least a five-minute warm-up slow run or brisk walk prior to your run.  I (now) always follow this warm-up with a regimen of stretches such as:
  • Basic IT Band stretch: Cross one leg in front of the other and reach down.  Also, reach up and over.

  • Seated cross-legged stretch: You can also lay on your back while doing this stretch for a deeper pull.

  • One-legged squat stretch: Cross one leg above the knee of the other leg and sit back in a squat.  I prefer to hold on to the wall or another stable object for a deeper stretch.

  • Kneeling hip flexor stretch: Your knee does not need to touch the ground.

4. Increase muscle strength and balance with the following exercises several times per week:
  • Band walks: Walk laterally side-to-side with band around ankles or do Monster Walks by walking forward as shown below.

  • Single leg balance exercise: While standing on one leg, focus on balancing then slowly bend down to touch first at your toe, slowly stand back up, then slowly bend down to touch outside your toe.

  • Leg lifts: Rest on your arms, using your core muscles (abs and glutes), lift your tush in the air and slowly raise the extended leg up and down slowly 20 times.  Also, you can perform small to large circles with the extended leg, or even pretend to write the alphabet with your foot.  Keep all movements slow.

  • Various squats and lunges with or without plyometric elements.  Land softly on your knees, use proper squat and lunge form.

ITBS can strike at any time so make these stretches and exercises just part of your routine.  Do not risk the emotional and financial consequences of being forced to miss scheduled races due to a preventable injury.  As runners, our miles are more than just burning calories or getting in daily exercise.  Running is our mental release, our therapy and outlet from daily stresses.  If banned from dashing due to ITBS or other injury, we are truly lost.

Dr. Trimberger, Oregon Sports Medicine
Dominic Chambers, DPT, North Lake Physical Therapy


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