How I Treated My Iliotibial Band Syndrome Be Fit Now

How I treated my Iliotibial Band Syndrome Be Fit Now
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How I treated my Iliotibial Band Syndrome

In Iliotibial Band Syndrome (ITBS) on March 13th, 2010 by Mark Having now tried just about everything to treat my Iliotibial Band Syndrome (ITBS) without going to see a therapist (physical or pyschological), I am fully ready to reveal what has worked for me.
What helps the acute pain?

Ice, Rest, and NSAID Pain Relievers (EFFECTIVE)
They all work, but treat the acute symptoms only (i.e., pain and irritation), and do not address any underlying causes of ITBS.
Iliotibial Band Strap (EFFECTIVE to VERY EFFECTIVE)

Yes, I can confirm these devices work. I bought one and found little information about how to wear it correctly. As a result, I went back and forth on whether I thought it was working, but then I got a key piece of advice from a website that stated the strap should be worn right over the portion of the ITB that is the locus of pain. I purchased the Pro-Tec Athletics strap, which is a neoprene strap with a n extra thick padded bump on it that goes right over the ITB. The strap is long enough that the end over-wraps this bump to force extra pressure right on the ITB, and then closes securely with hook and loop tape (e.g., Velcro). See my video below, which illustrates how I wear my ITB Strap.
http://www.be-fit-now.com/how-i-treated-my-iliotibial-band-syndrome
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The ITB strap seems to prevent irritation from developing, so that I could keep training while my underlying problem healed and I learned better running form. Once I figured out EXACTLY how to wear it, I was able to run indefinitely without any sort of pain at all. I went from three-four miles runs without the strap that ended because I began to feel a little ITB pain, to a 6 mile runs that was totally pain free within a week when I was wearing the strap and had it positioned just right. Two weeks later, I routinely run 6 miles with the strap, and have no pain, and often simply carry the strap with me, just in case I detect any twinges, so I can put it on to stave off a more severe flare-up. This reduced/eliminated my inflamation and allowed me the freedom to continue working on my form (biomechanics see below), which had already begun to help.
What solves the real problem?

Biomechanics (VERY EFFECTIVE, treats the root causes, but takes time and retraining)
ITBS is inherently due to biomechanics that causes stress through inefficient or pathological movement and neuromotor patterns when exercising. If you can learn to move correctly when you are exercising, you can alleviate these stresses. Some people may require orthotics to achieve improved motion, although orthotics should probably not be used as a substitute for good biomechanics. I suggest learning ChiRunning form, which is what helped me. Within a couple of weeks of starting ChiRunning, the distance I could run before the onset of ITBS pain tripled, and I began to identify the specific aspects of my running form that were contributing to my ITBS.
Strengthening (EFFECTIVE, treats part of the root cause, but takes some time for effects to become obvious)
As part of ChiRunning, certain exercises to strengthen the core muscles are recommended and these are the same ones independently recommended by a variety of biomechanics experts to strengthen build strength and neuromuscular coordination that stabilizes the hips when running, alleviating rotational torque at the knee with each stride which also contributes to excessive pronation. Key muscles groups that were overlooked in the past, but which appear to show some promise for supporting the improved biomechanics needed to alleviate problems contributing to ITBS include the gluteus maximum and medius, and exercises that strengthen them include bridges and hip adduction exercises. Orthotics can also help reduce overpronation that contributes, but in my opinion orthotics should be sought only after biomechanical strengthening and biomechanics prove unsuccessful. Recent research suggests that many overpronation
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problems are best addressed from the top-down (strengthening and biomechanical improvements) rather than bottom-up (orthotic ) approaches.
What didnt work as well for me?

Stretching, Foam Rollers/Self Massage (SOMEWHAT EFFECTIVE for relief from acute symptoms)
My impression is that stretching does not work well for preventing ITBS, but did reduce some of the discomfort after it had arisen. Despite what seem like rational theories about how inflexibility causes ITBS, there is little empirical evidence to support the claim, and my experience was that none of the many stretches, foam roller stretches/massage, and manual self-massage I was doing was effective for preventing ITBS inflammation, but did seem to provide some relief of acute pain once inflammation had started. If you seek treatment, and the only advice your practitioner gives you is to stretch, because they believe that ITBS is a lack of flexibility problem, I suggest you seek a second opinion and additional advice.
Conclusions
From weeks and weeks of research and through trial and error I have arrived at the conclusion that ITBS 1) Sucks, 2) IS treatable with rational approaches, and 3) responds well to a multi-pronged treatment approach. First, treat acute flare-ups by stopping, resting, icing and taking NSAID pain relievers (as directed, for their anti-inflammatory effects). Second, start a regimen of strengthening exercises for hip adductor and butt muscles that help with hip stability. Third, put some effort into improving running form/biomechanics. Fourth, use an ITB strap to stave off acute inflammation, while focusing on form. Good running form may require the use and strengthening muscles that have become weak and atrophies from disuse before it is possible to maintain improved form over long distances. Decrease running distance at first until you have the form down, and then begin to increase distance. Dont worry much about pace If you run, the pace will come. Stretching, and self-massage (including foam roller work) may provide relief from acute ITBS pain and help recover faster. So, as you can see, what Ive determined is most successful for me is a multi-pronged approach including judicious use of a variety of tools that serve to reduce acute symptoms, so I can recovery more quickly, strengthening and biomechanics improvements to treat the factors that cause ITBS, and supports/orthotics to either aid in improving biomechanics or preventing inflammation during my runs. The most effectively things have proven to be 1) biomechanics improvement, 2) strengthening of hip musculature, and 3) keeping my ITBS strap with me or wearing it during runs, as a means of preventing acute symptoms from developing. Foinally, there is a lot of conflicting information out there on ITBS, and people have different experiences with it. This article describes my experience, and I think some of my observations may be helpful to others. If you feel compelled to seek the help of a Physician or Physical Therapist, by all means do so, but make them earn your dollars. If they just want to treat the symptoms and arent talking to you about how you run, then bring that up and/or seek additional opinions. Title: How I treated my Iliotibial Band Syndrome Technorati Tags: biomechanics, injury-prevention, ITBS, running, strength-trianing Be Fit Now Keywords: biomechanics, injury-prevention, ITBS, running, strength-trianing
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Comments (8) on How I treated my Iliotibial Band Syndrome

1. Mark Coleman says: March 14, 2010 at 4:55 pm As an aside, one key aspect of running form is cadence. If each of your feet hits the ground less than about 85 times per minutes, and you suffer from ITBS, you may be at greater risk of developing symptoms, as the length of the stance phase or running (the amount of time each foot is planted on each stride) appears to correlate with ITB inflammation. Reply 2. Matt says: June 5, 2010 at 2:39 pm Mark, Can you email me please at [email removed for user security]? I have a few IT questions and you seem to know a lot about this? I would really appreciate it if you could help answer some questions please. Reply 3. Debbie says: September 29, 2010 at 10:46 am The focus of my pain is BELOW my kneecap, right on the bony protrusion of epicondyle, just below and to the outside of my knee. So how should I wear the strap? Reply Mark says: September 29, 2010 at 11:43 am Debbie, if your pain cannot be localized when you press around on your leg and knee just above the top of your knee cap and squarely on the side of your leg (the outside), I suspect ITBS is not what is going on with you. If its squarely on the side of your leg, but right below the level of the bottom of the knee cap (right AT the joint which may feel like its right ON the protrusive part of the lateral epichondyle, I believe you should see a physician to make sure you do not have a sprain/strain/tear of your LCL (Lateral Collateral Ligament, which lies almost directly under the ITB at that location. In that case, the ITB strap would probably not work for you, but a knee brace may offer some support and relief until the injury heals, which cold take several weeks. Another injury to rule out in your case is a meniscus injury. In extreme/severe cases of either of these injuries, surgery may be necessary to remove meniscus and/or repair the LCL. Id see a orthopedist who specializes in sports injuries for a good diagnosis. See this site for a general description of LCL sprain to see if your symptoms are consistent with this injury: http://www.sportsinjuryclinic.net/cybertherapist/front/knee/ilateralligament.html ITBS is very specifically the result of inflammation of the highly innervated fatty tissue that resides under the ITB, above the lateral epichondyle on the side of the upper leg, which is just above the level of the knee cap when standing. If light to moderate pressure there doesnt cause
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some pretty sharp pain, Id say ITBS is probably not your primary issue. Best of luck in getting this sorted out. The knee is a complicated joint, and a lot can go wrong. Worse, the different things that go wrong can have similar symptoms! 4. Debbie says: September 29, 2010 at 1:00 pm Thanks for the input. With my left IT band (summer 2009), I went to a sports medical doctor who did tests and x-rays on my knee, diagnosing me with ITBS. Went to lots of physical therapy to strengthen hips / glutes. Began using the Stick and foam roller. Ran WITH the strap (wearing it about where you show in your video), and had good success with it being helpful. This year in August when I started having issues with my right leg, it felt exactly the same. I started running with the strap, but it had to cut my mileage WAY down. Currently seeing a sports chiropractor who does ART, and at his recommendation,using Kinesio Tape. Is is helping? Hard to tell. Seems like it just has to have TIME to heal no matter what. Reply Mark says: September 29, 2010 at 3:34 pm Unfortunately, time, rest, and easing back into things is what EVERY successful recovery from ITBS I have ever seen have in common. Some of the treatments help relieve the inflammation. The strengthening and improvements in form (learning to midfoot forefoot strike and run with stable hips and legs and knees and feet tracking straight) help prevent/reduce ITBS symptoms, and thats enough to solve the problem entirely for some people. For example, I was able to get past it by taking time off, stretching, massage, and the strap to reduce the inflammation, then strengthening and easing back into running with better formBUT I have had to continually monitor my form. Ive been able to monitor less and less as better form became automatic, but I still have to check myself out to make sure Im not slipping back into old/bad habits. For me, so far, so good, but there are some anatomical issues that women often suffer a little more from than men, that might make ITBS a little harder for many women to shake. Women are generally a little shorter, and generally have wider hips relative to their height, than men. The result is that the angle of the femur from the hip to the knee (sometimes called the carrying angle) is a couple of degrees further from vertical than in the average male. That causes an extra mechanical load on the inner knee and sometimes more inward flexing/rotation of the knee when bearing weight, a movement that research has shown to be correlated with ITBS (and which appears to be a top-down cause of overpronation for many people). Often, while running, ITBS pain feels like it is more specifically located at the knee, but when you rest a bit and are able to walk normally again. Ive not used kinesiotape for the ITB, but have found it useful for other things. Its worth a try. A note, and Im not sure if this will be helpful to you, but the one aspect of my form that appeared to alleviate my ITBS the most when I started running again and experienced some pain on the run, was hip stability. I found that if I just engaged my lower abs, and tucked but butt in a little (very subtle, not clinching) throughout my entire stride, and kept my hips level, so that they did not tip so much from side to side as I ran, it resulted in less inward rotation of my knees and alleviated my pain.
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5.
Andrew says: May 29, 2011 at 8:52 pm Mark, Thanks for providing such a broad coverage and insight into this problem. As we all google away to solve our problems, its good to see useful hits like this pop up. Just wanted to add my thoughts on your comments regarding pain on the lateral epichondyle, where you have suggested it is not ITBS. Contrary to this, my understanding is that pain is commonly felt at the lateral femoral epichondyle (Clinical Presentation http://www.aafp.org/afp/2005/0415/p1545.html, or http://web.mac.com/kinetichealth/Kinetiic_Health__Online/Blogging/Entries/2006/11/20_Understanding_ITBS.html). In your case it was further up the ITB. I figure that ITBS can flare up at many places along the band. My pain began shortly after my longest training run for a half marathon. It then presented itself with acute pain in a short run a few days later. This was two weeks before the half marathon. I managed to get through the half marathon with antiinflammatories, a knee brace, and a lowered goal time. Since then I have stopped completely . I have seen a physio who has diagnosed my pain as ITBS. At first I couldnt pinpoint the pain, however 2 weeks in and it is now very specific right on the lateral epicondyle. The two alternative conditions you mentioned injurying the LCL or lateral meniscus, are very unlikely to occur in a runner, and more likely to come about after an impact injury (i.e. football tackle). I also see them as much more serious injuries (ITBS sounds better..!) Furthermore, although Im yet to test it, I would expect the strap to provide some relief no matter where the pain is. Hopefully placing the strap a few inches above the knee (same place you put it) will restrict the movement of the band and decrease the inflammation where ever the site of pain was. Meanwhile, Im waiting for the straps and a foam roller to arrive in the mail. Im stretching my ITBS and strengthening hip muscles and looking at correcting my overpronation. As you observed we cant help but try EVERTYHING ! Reply Mark says: May 29, 2011 at 9:55 pm I can easily see pain developing at the lateral epichondyle, as you describe. Anywhere there is fascia/bone attachment, there is a potential for the attachment points to become stressed. Further, since they are not highly vascularized, healing can be slow. Iliotibial band Syndrome is called a syndrome because it is poorly understood, and the term applied to a broad range of pains that are probably due to different types of inflammations in soft tissues and fascia along the later femur, knee and upper lateral tibia, even. My own research and thinking has evolved on the subject over time. Rather than re-applying the label ITBS to a specific inflammation, I think it actually is appropriate to apply it to a broad range of inflammations that occur int he region. That, after all, is how essentially how the term syndrome is applied in medicine. Unfortunately, that doesnt leave those of us who periodically suffer with it with any greater
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certainty about how we should treat our problem. Some of us will probably find long term relief from improvements in running form, whereas some may find it difficult to find relief at all. The more Ive studied ITBS, the more Ive seen that while what I did works very well for some people, my earlier attempts to narrow the scope of the ITBS diagnosis still has the effect of leaving a lot of folks out in the cold with no explanation and no clear path to alleviating their pain Even so, some combination of the approaches Ive mentioned does seem to help most people with ITBS. Some psychologists say, Therapy is where you find it. I believe this should also be said by a larger number of practitioners seeking to help people with the types of vague problems we often end up calling a syndrome, like ITBS. With diligence and persistence, and most of all sufficient rest and proper rehab, I have confidence you will overcome your bout of ITBS. All the best to you and cheers.
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