Monday, July 9, 2012

How to identify, treat ITBS

From my fitness column:

Q: “What do you do to get over ITBS problems? My sister-in-law had it while training for the Marine Corps Marathon.”-- Susan A.

A: First and foremost, the one word athletes loathe to hear: RICE  (Rest, Ice, Compression and Elevation)

No, not this kind of rice.

My first experience with ITBS (Iliotibial Band Syndrome) was roughly 14 years ago, though, at the time, I had no idea what was causing the extreme pain at the side of my knee and left me nearly unable to climb the stairs after a run. But then I had three kids in five years and running was put on hold, allowing the band to heal.


When I resumed running several years later, the pain returned. I’d start off feeling great and then, like clockwork, I’d hit the two mile mark and the side of my knee would begin to ache. Sometimes I could run through it; other times, the pain got worse with each step and, every time, my knee was left feeling stiff and sore afterward. Scouring the internet, I found that my symptoms exactly matched those associated with ITBS. My father-in-law, who was working as a Physical Therapist Assistant, agreed with my self-diagnosis and recommended several stretches to loosen my Iliotibial (IT) Band. After a period of rest and, subsequently, following a strict stretching regimen, I've had no further problems with ITBS, which, according to, is the most common cause of pain on the outside of the knee in runners.

ITB Stretch
The IT band, which stabilizes the knee, is a thick band of fibrous tissue that extends from the outer edge of the pelvis, crosses the hip, and inserts just below the knee. According to, the irritation usually occurs over the outside of the knee joint at the lateral epicondyle, where the femur bone ends. At this point, the IT Band crosses over bone and muscle, and a thin bursa, or fluid-filled sac, located between these two structures, is designed to reduce friction and facilitate a smooth gliding motion. However, when the band becomes inflamed from the repetitive motion and continual extension and flexion of the knee during running, it does not glide easily, resulting in pain at the outer edge of the knee and sometimes a stinging sensation along the entire length of the band.


ITBS can be caused by a number of things, including running on banked surfaces, inadequate warm-ups or cool downs, excessive hill running, a sudden increase in mileage or intensity, high or low arches, supination of the foot, over-pronation, uneven leg length, a tight IT band, weak hip abductor muscles and worn-out shoes.

In addition to RICE, stretching and anti-inflammatory medications can be used to treat ITBS, as well as foam rollers to loosen the IT band. Taping and wrapping the knee, which provides support and compression, also are effective treatments. Consulting a physician, physical therapist or massage therapist, especially one with experience treating sports-related injuries, is always a good idea.   

Once the acute symptoms of ITBS have been addressed, it’s important to continue building strength and flexibility of the hip and knee as well as including cross-training in your workouts. Be sure to change your running shoes every 300 to 500 miles and to slowly increase running mileage and intensity. Most importantly, be sure to cool down and stretch thoroughly after each workout. 

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