Iliotibial Band Friction Syndrome

It is very encouraging to see that in India awareness regarding health is increasing by leaps and bounds. Year around one can see lots of people, especially young individuals   jogging and running taking part also in 5K, 10K, half marathons, full marathons or long cycling trips. Unfortunately, most of these young individuals learn about warming up, stretching exercises and cooling down which is usually inadequate. So they become prone to many sports related injuries. One of the commonest injuries in above mentioned events is ITBFS- Ilio-tibial band friction syndrome or ITB syndrome. It is also seen in wrestlers as well as Kabbadi players.Running injury, Ahmedabad, INDIA


The iliotibial band is a thickened fibrous band that runs from pelvic bone all the way down to the outside of the thigh & inserts in the upper part of the shin bone known as tibia. This band has few functions, one of them is to connect major hip muscles to the knee, The other function is to keep thigh muscles into place to increase their efficiency to perform. It seems to have stabilising knee function during foot strike which is very important for a long-distance runner.


How does pain precipitates?

Usually this is an overuse injury in most of the athletes. Too frequent training or too fast increase in the running distance or training weights are the most common causes of ITB friction syndrome. When the knee is bent and straightened as in running, cycling or in other activities, the band gets rubbed on the bony bump on the outside of the upper part of the knee joint (Femur bone). ITB syndrome accounts for approximately 8% to 10% of running injuries & common in both the sexes as well as in recreational & elite runners or cyclists. Most susceptible group for ITBFS is between 20-40 yrs. of athletes. It is believed that more than 1 million people are affected in India with this problem.


How does it feel?

ITBFS pain appears near the end of the session and disappears on stopping, over a period of time. Gradually frequency of problems increases. It can progress from a dull ache to a sharp pain with or without burning sensations. It hurts more going downhill or in cross legged sitting position. It If this is ignored and if he/she continues doing the same activity, the pain becomes more intense and starts appearing early in the session and takes more time to disappear. Sometimes there is burning sensations due to inflammation of a small nerve lying in that area. If it becomes more, an athlete is forced to stop his sport.


Why ITB syndrome?

There are many causes for this syndrome. The main are………

1/ Overuse: Technically this is an overuse injury & one has to understand this for recovery. Overuse without proper body preparation is one of the main causes of IT band friction The remedy starts with icing and resting for few days till irritation is over. Next step is to change the training regimen. One should try by changing running route or get away from the treadmill to jog outside. Try some cross training while you slowly increase your kilometres.

2/ Tight hamstring muscles or muscles of back part of leg is considered as a major contributing factor to this problem [common in cyclists]. Hip muscles are connected to the knee by IT band so proper evaluation and exercises of hip and back muscles is  very important. It is very easy to stretch these muscles and we have found yoga ( Butterfly pose, Parivratt Trilokasana, Supt Matsyendrasnan etc.) to be very good for this problem. This should be done every day before starting the run. If you cannot do it, take help of a sports medicine expert and physiotherapist 


3/ Hip muscles: Weak hip muscles is one of the biggest reasons that Micheal Fredericson from Stanford university found out for the cause of ITBS in his research. Strengthening various hip muscles is a very important part of ITB syndrome healing. Along with the hip muscles, one should also strengthen the lower back muscles and for this once again we will insist for yoga training.

4/ Poor running form

One will be surprised that  little change in the running pattern can get rid of ITBS. Ask a more experienced runner to evaluate your Gait pattern. Over striding, that is taking too long of steps or strides that cross over the midline of the body could be the causes of your problem. These are pretty easy to notice by an expert eye. Very rarely one might need professional video gait analysis & treatment.


5/ Shoes & orthotics

Shoes is the most imp. part of the gear in any sports. Examine the soles of your shoe. If they have given way or they are more rubbed on outer or inner side, it reflects problems in the architecture of your foot or your running form. Over worn shoes can cause your foot to land at an awkward angle, which transfers lots of stresses to the knee, hip and spine. Harder the soles, more is the impact. So changing your shoes within their recommended mileage is essential. If you are a regular jogger or runner, not only it is important to buy a running shoes from a reputed manufacturer but also to change them at every 1200 to 1500 kms. of use depending on the terrain you are running on. If required gel insoles or orthotics should be inserted inside the shoe to improve the running pattern and to reduce injuries If you are a barefoot runner, you must keep ITB syndrome in mind because one is likely to get more problems if the foot architecture is not right.


What one should do to make it heal?

As discussed, there are multiple causes for iliotibial band friction syndrome,  1st step of treatment is to stop runningNishith Shah , AHmedabad or take part in precipitating sports till the time pain is almost gone. In acute stage, icing of inflamed part is done by using an icepack or crushed ice wrapped in a towel. This is applied for 15 to 20 minutes at the painful area every 3 to 4 hours for few days. Anti-inflammatory medicines (NSAID) can hasten recovery in case of excessive pain. Electrical modalities in a physiotherapy unit in form of ultrasound, IFT & supervised stretching as per recommendation by a sports medicine expert can help in recovery.


If pain still persists, one can have an injection at the tender area. The world is moving away from a steroid shots. Better injection modalities like Prolotherapy is available. So do not be afraid for taking a shot if your ITB syndrome is affecting your daily life, but avoid steroid. Surgery to release ITB & to remove inflamed tissue will be the last resort & is hardly needed.


How to prevent ITB syndrome?

1/ Start with a walk before u start running- approximately 500 meters of walking before running is mandatory

2/ Do warm up exercises like Hip muscles stretching, calf stretching and back muscles exercises. Cooling down with stretching after an event is also very important. It helps to relax overloaded muscles, removes lactic acid accumulation, lowers body temperature & heart rate. This in turn prevents chronic injuries.

3/ Examine your shoes repeatedly. They should be without any visible sole damage. If you are a serious runner, replace them frequently though they might appear good from the top

4/ If your foot is deformed, have orthotics [inserts] after consulting a sports medicine specialist or a podiatrist

5/ If possible don’t run on the inclined surface [side of the road], on a concrete surface or extremely hard surface.

6/ While running frequently change directions repeatedly so that a particular group of muscles or joint is not overloaded.

7/ Do not try to match the pace of a fast runner. Choose your own pace. It will be better find out a colleague who can match your side strides & run with him/her.U will enjoy the exercise & have less injuries.

8/ When increasing mileage, stick to the rule of increasing it by no more than 10% every week.

9/ Cross train with activities like swimming or cycling if possible.

10/ If you are attempting to do a half marathon or full marathon, additional muscle strengthening and stretching exercises in a gym will help you to increase your performance

11/ Reduce kilometers or take a rest for few days once you start experiencing pain of iliotibial band





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