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If you’re a runner or cyclist, the chances of you having iliotibial band syndrome at some point is quite high since it’s the second most common running injury. If you’re not a runner but regularly engage in physical activity that involves repetitive knee motion, then you’re also at risk. What if you never engage in any athletic activities? If you currently have knee pain or lower back pain, it could be caused by your IT band not working optimally.

What Is It?

The iliotibial band (ITB or IT band) is a thick band of fascia that runs down the outside of the thigh from the pelvic bone to just below your knee on the tibia (shin) bone. Where the ITB passes the knee, there is a water-filled sac called a bursa. The bursa functions like a water balloon to reduce friction and wear of the ITB against the bony bump of the outer knee. Iliotibial band syndrome takes place when the ITB becomes swollen and irritated from rubbing against the bone on the outside of your knee.

The ITB’s primary function is to control and decelerate the adduction (inward movement) of the thigh when the heel strikes the ground, as during running. The ITB crosses two joints, the hip and the knee joints, so it can be involved in problems in both areas. The ITB is most commonly implicated in knee pain issues but is also involved in the development of some forms of “snapping hip” and in trochanteric bursitis.

Typically, iliotibial band syndrome results from an overuse injury, seen most commonly in long-distance runners and other athletes whose sports require a great degree of knee bending. The condition is also commonly seen in cyclists, soccer and tennis players, skiers, and weightlifters (especially those doing power-lifting moves, such as squats).

How to Prevent It

Surgery is rarely necessary to treat iliotibial band syndrome. As with many acute and chronic inflammatory conditions, surgery is considered the last resort. Plus, there are many things you can do yourself to heal and prevent iliotibial band syndrome.

1. Walk First

Before engaging in running, biking or another knee-bending exercise, walk a quarter- to a half-mile. This helps warm up your whole body, especially your legs, for more strenuous exercise. This is one of the best running tips for beginners and for anyone dealing with ITB pain.

2. Rest

One of the best and easiest things you can do for iliotibial band syndrome once you have it is to rest. The condition typically improves when the activity that provokes pain is avoided. If you feel pain on the outside of your knee, you should take a few days off from your usual exercise and decrease your mileage/length of workout when you return.

In the majority of runners, resting immediately prevents pain from returning. If you don’t give yourself a break from running, iliotibial band syndrome can become chronic.

3.  Stretching & Strengthening

Consistently stretching the iliotibial band, hamstrings, quadriceps and glutes is one of the best things you can do to prevent and treat iliotibial band syndrome.

One study in the Journal of Chiropractic Medicine even showed that a runner’s low back and sacroiliac pain seemed to originate from a dysfunctional iliotibial band. This case illustrates how important it is to consider iliotibial band tightness as a possible cause of low-back and sacroiliac pain and that proper management may need to include stretching of the iliotibial band.

Strengthening the hip abductor muscles has also been shown to be helpful for ITBS. A study in the Clinical Journal of Sport Medicine showed that long-distance runners with ITBS have weaker hip abduction strength in the affected leg compared with their unaffected leg and unaffected long-distance runners. Additionally, symptom improvement with a successful return to the preinjury training program parallels improvement in hip abductor strength.

4. Running Modification & Gait Analysis

Try to run on flat surfaces, avoiding concrete surfaces as much as possible. When running on a track, change directions repeatedly. You can also try wearing a bandage or knee sleeve to keep the bursa and ITB warm while you exercise.

Modification of a runner’s actual way of running — aka his or her gait — has also proved to be very helpful for iliotibial band syndrome. Gait analysis is a common and very helpful way to alleviate ITB issues.

One study of a 36-year-old female runner with a diagnosis of left knee ITBS, whose pain prevented her from running greater than three miles for three months, showed how a change to her gait directly led to her recovery from iliotibial band syndrome. This subject’s foot strike and vertical displacement were evaluated and improved during the course of study.

These changes to her gait led to complete recovery from knee pain six weeks later. She was able to run up to seven miles with comfort and an improved feeling of strength by implementing her new gait and running form.

5. Ice & Heat Therapy 

Both cold and hot self-care can help your iliotibial band heal. Use a heating pad or hot water bottle on the painful area to warm the area up before activity. Then, use ice following activity to decrease the possibility of pain. You can apply ice to the painful area for 15 minutes every two to three hours. Do not apply ice directly to your skin.