ITB Syndrome (foam rollers begone!)
Iliotibial band syndrome (ITBS) is a rather common cause of lateral knee pain, especially so among people who enjoy running or walking. Symptoms typically present as pain in the outer knee area, particularly during or after exercise, or when climbing or descending stairs. Without addressing this, it has the potential to develop into a long term issue for many people.
The ITB is a long connective tissue that runs from your lower back, down the outer thigh before attaching to the outer part of the knee. Until recently, there were theories that this issue was caused by a tight ITB, thus frictioning or rubbing the structures that sit underneath it at the knee.
In the past, common practice was to spend hours torturing yourself on a foam roller, often causing more pain than the injury itself. If you weren’t doing that, you were spending $80/session with your physiotherapists elbow jammed into your thigh, likely leaving a few bruises and causing a few tears. At the time it made sense, rub/massage/roll the tight structure and it will get looser, right?
While ITBS is still a condition without a clear consensus on physiotherapy management, what we do know is that the ITB is an incredibly durable and stiff structure, requiring hundreds of kilograms of force to stretch it by the smallest margin. So, get rid of the foam roller and stretches, because you’ve likely just been torturing yourself without any credible benefit.
Instead, focus on reducing the aggravating activity (like decreasing your running volume) and work on strength and control around your hip and knee. These joints control the tension and forces applied to the ITB and the structures surrounding it. Here are some simple exercises that a rehab program might include, progressing from the easiest to the hardest:
1. Side-lying hip abductions and glute bridges (Low level/easy)
2. Squats and step ups (Mid level/moderate)
3. Single leg squats and banded hip abductions (Higher level/hard)
Given that it takes anywhere from 5-8 weeks for muscles to begin adapting, I would expect a process of at least 6-8 weeks of progressive strength exercises before considering an increase or return to usual running/walking activities. That being said, once you get back to running it’s important to schedule in at least 1-2 strength sessions each week. This could include exercises like lunges, squats, deadlifts and any other exercise to thicken those chicken legs.
Why is strength training important? Because it reduces your future injury risk, and enhances your performance. Meaning, less time in the physio clinic and more time pounding the pavement.
