Iliotibial Band Syndrome
Do you have:
- Pain on the outside of your knee or hip region?
- Sudden or gradual decreased endurance
- Feeling of hip or knee instability
ITB Syndrome is usually caused by:
- Leg length discrepancies
- Contracted tensor fascia lata muscle and IT band
- Adhesion between IT band and lateral quad muscle
- Improper joint mechanics in the ankle, knee or hip
If your knee pain is lateral (on the outside edge of your knee), then it's likely that you are suffering from one of the most common knee complaints - iliotibial band syndrome (ITBS). As you may have learned the hard way, ITBS may aggrieve your knee enough to drastically limit or even completely stop your training. It is estimated that 60 per cent of all runners are injured in an average year, and about one-third of those misfortunes occur at the knee, producing a yearly incidence rate of one in five runners.
The syndrome is often labelled an 'overuse' injury, but that's a very poor way to describe the origin of the problem, since it implies that the main source of difficulty is excess mileage. The truth is that runners can be afflicted with ITBS on a regime of just 5 to 10 miles per week, even though such volume would hardly constitute overtraining. The key source of ITB disorders is actually a lack of strength and flexibility in the iliotibial band, sometimes combined with a perverse fondness for running either on the track or on crowned roads. The function of the ITB during running is to control and decelerate adduction of the upper part of the leg. (90 times per minute per leg as you run and almost 22,000 times during a four-hour marathon).
What makes things especially tough for the tensor fascia lata is that when the right foot makes contact with the ground and the left leg begins to swing through there is a natural tendency for the left hip to drop temporarily, pulled down by the omnipresent force of gravity. As it does so, the pelvic girdle 'rocks' like a seesaw; the right hip goes up as the left hip goes down.
As you probably guessed, since the ITB runs from the hip down to the knee, the upward movement of the right hip stretches the tensor fascia lata and overall ITB at the precise time that it is trying to shorten and control adduction of the right thigh. That constitutes an 'eccentric' movement of the tensor fascia lata, and eccentric actions are the ones which can be especially trauma-provoking to muscle and tendon tissues.
As often as not, the pain won't really hit home until the first one or two miles of a workout have been completed. Once it starts, the pain tends to be persistent if you keep going - and frequently gets worse during downhill running (and while walking down steps). The discomfort may radiate up and down the leg, but - strangely enough - the pain will often almost disappear if you stop running and begin to walk slowly and with short steps.
ITB problems don't always occur at the knee. Pain may also be present below the knee, where the ITB actually attaches to the tibia, and discomfort may also occur much higher up - in the tensor fascia lata itself or in its tendinous connection with the hip.