Iliotibial Band Syndrome.

You love to run. For some of us, running is the element of our lives that smoothes all the rough edges. It keeps you fit and healthy, as well as happy and productive. But sometimes the miles you run turn around and bite you in the form of overuse injuries. The nature of the sport, the terrain, genetics, body type, and training habits can conspire to turn your love sour. One of the most frequent overuse injuries to bite a runner is Iliotibial Band Syndrome (ITBS), accounting for as much as 12% of all running-related overuse injuries.

What It Is

The Iliotibial Band is a thick strap of tissue, which extends from the outer rim of the pelvis (when you rest your hands on your hips, the bone they sit on is the ilium) to the outside of the knee. The long band connects the gluteus, pelvis, and femur, all the way to the lower leg at the top of the tibia--hence, Iliotibial Band. The Iliotibial Band is a very hardworking piece of anatomy for the runner, helping to stabilize the knee and rotate the leg for the foot strike and push-off. At foot strike the Iliotibial Band is in front of the lateral condyle of the femur (if you run your fingers down the outside of your thigh, you'll run into a bulge of the bone just above the knee--this is the lateral condyle). During push-off the band slips behind that bony prominence.

It is this constant movement of the Iliotibial Band back and forth over that bony bump that causes problems. The bursa located at that site is designed to buffer friction and takes a beating, especially for long distance runners and even more so for those with a tight Iliotibial Band. When the bursa becomes inflamed, the Iliotibial Band itself becomes inflamed, and that inflammation registers as intense pain. Friction and inflammation of the Iliotibial Band can also occur at the upper end of the band, which is felt as hip pain. There are, however, many causes of hip pain and as in all overuse injuries, your diagnosis should come from a sports medicine professional.

Why Does It Happen

* Often, Iliotibial Band Syndrome hits less experienced runners who increase mileage too fast. A sitting duck for the syndrome is the low mileage runner who decides to train for a marathon, piling up the training miles too quickly. Relatively weak knee flexion and extension muscles have been blamed in some studies, along with poor braking (eccentric) forces. These are all problems that can be found in runners whose conditioning isn't adequate for the demands of long distance running. An experienced runner may also suffer the same conditioning problems after a layoff if you increase mileage and intensity too fast.

* "Do you regularly run on one side of the road?" This is one of the first questions a doctor will ask you if you appear with Iliotibial Band symptoms. It is the leading question for functional leg length discrepancy, which along with actual leg length discrepancy are risk factors for Iliotibial Band Syndrome.

* Other anatomic variations can set the stage for ITBS including "bow-legs," an unusually tight or thick Iliotibial Band, and excessive pronation.

* In research from Stanford University comparing runners suffering ITBS with non-injured controls, runners with the syndrome had significant weakness in the hip abductors of the affected leg. Rehab that focused on strengthening the abductor muscles rendered 92% of the injured runners pain-free within six weeks.

What Can You Do About It?

In the first place, take heart-invasive and expensive tests aren't used to make the diagnosis. It depends on a good history and physical exam. And even more important, this is not a surgical condition. Treatment should be limited to biomechanical changes, physical therapy, training changes, orthotics, and especially strength and flexibility training. The bad news is that returning to running too soon will almost certainly result in a return of symptoms. Take adequate time off to reduce inflammation, correct underlying problems, and rehabilitate; then return to running very gradually, never running in spite of pain. Otherwise Iliotibial Band Syndrome may become chronic and recurring.

Hip abductor weakness is a key factor in Iliotibial Band Syndrome and a good strengthening plan is key to recovery. Abductors move the leg away from the centerline of the body--stand on one leg and without bending either knee lift the leg straight out to the side. That's abduction and the muscle most responsible for that motion is the gluteus medius. In a slim, muscular person you can see this muscle clearly as the band of muscle that wraps around the top of the femur at the hip. It's on the side of the buttocks, the most lateral of the gluteus muscles.

(Clinical Journal of Sports Medicine, 2000, Vol. 10, No. 3, pp. 169-175; The Physician and Sportsmedicine, 2000, Vol. 28, No. 2, pp. 53-68; Orthopedics, 2000, Vol. 23, No. 11, pp. 1214-1215; American Family Physician, 2000, Vol. 61, No. 7, pp. 2109-2118)

RELATED ARTICLE:PREVENTION BEATS All STRENGTHENING & STRETCHING EXERCISES

Here are the two exercises prescribed in the study from Stanford University to strengthen the hip abductors. Exercises should be repeated on both sides, even if you're treating an injury on one leg.

* Leg Lifts--Lying on your side with the underneath leg bent for support, tighten your abdominal muscles, rotate the moving leg slightly inward pointing the toes down a bit toward the floor, heel slightly pointing upward. This helps to isolate the gluteus medius. Slowly lift your leg to 30 degrees and hold for one second. Repeat 15 times building up to three sets. Increase the number of repetitions, as you are able without pain.

* Pelvic Drops--Stand on a stair sideways with one leg on the stair and the other suspended above the floor. Without overarching your back (don't stick your rear end out) and without bending the supporting leg, lower the unsupported leg a couple of inches below the level of the stair and lift it back to the starting position. The action will come from tilting your pelvis laterally. Do the exercise slowly through the range of motion concentrating on isolating the gluteus medius of the supporting leg to lift the leg back to level. Work up to three sets of 15 repetitions and add repetitions, as you are able.

STRETCH--Increasing flexibility of the Iliotibial Band is also important for rehabilitation to help minimize the friction forces. Here's the classic Iliotibial Band stretch:

* ITB Stretch--In a standing position, cross the unaffected leg in front of the other leg and lean your upper body away from the back leg. You can lean against a wall for balance. This exercise can be repeated several times throughout the day for maximum benefit.

PREVENTION Don't Assume You're IMMune

One extra long run or a hard session on hills may be all that lies between you and ITBS.

Prevention is your absolute best bet for dealing with this and a host of other overuse woes that afflict runners.

* Add strength training to your workout. This is a favor you can do for yourself that has a huge list of payoffs, not least of which is injury prevention.

* Stretch. While there is lots of controversy in this department, in general, it is well understood that if the Iliotibial Band is too tight, it can create pain and inflammation. And, it responds well to stretching exercises, which can be excellent insurance against developing this common problem in the first place.

* Mix up the direction you run. Always running in the same direction on canted roads can over-strain the Iliotibial Band of the "long" leg, which increases the friction suffered on that side.

* Cross train. Take days off from running by choosing another activity that doesn't aggravate the same structures. Rowing, swimming, and elliptical trainers can help offset the demands of running.

* Train wisely. Never increase mileage or intensity by more than 10% per week.

* Get expert advice. Have a professional evaluate your mechanics and correct problems before they cause an injury.

* Never underestimate the importance of rest and recovery. Remember not to do two back to back hard days. Alternate long days with low mileage, save hard days for once or twice a week, and take days off.

* Shoes and Orthotics. If over-pronation or leg length differences have contributed to your problems, orthotics or other shoe adjustments can make a huge difference.