Beating the Band
New Treatment for IT Band Syndrome Yields Results
By Brian Fullem, D.P.M.
As featured in the May 2004 issue of Running Times Magazine
Iliotibial band syndrome (ITBS) can be a debilitating injury to a runner. The IT band, as it is more commonly known, can become so painful that a runner is unable to train at all. Mark Fadil, the Director of Sports Medicine Institute International (SMI) in Palo Alto, CA, knows this injury both personally and professionally. As a high-school senior, Fadil won the New York state 3,200m championship in 9:10. After one successful collegiate year, Fadil developed pain on the outside of his knee on the fourth day of his sophomore year. He was diagnosed with IT band syndrome and, even though he was receiving regular treatment—including NSAIDs, ultrasound, stretching, and two cortisone injections—the pain progressed to the point that he could not even run a mile. Nine months later, he turned to physiotherapist Gerard Hartman, and after 11 days of deep tissue massage, stretching, and strengthening, he was able to train again, finishing his career at Stanford as a team captain with an 8:50 best in the 3,000m steeplechase.
What It Is, What It Does, What Goes Wrong
The IT band begins in the hip as the tensor fascia latae muscle and has attachments at the origin from three different muscles: the gluteus medius, gluteus minimus, and vastus lateralis. The muscle becomes a fibrous band of tissue as it progresses down the thigh, then crosses the knee joint, and inserts along the lateral (outside) portion of the patella (knee cap) and into the tibia (shin) bone on a bump known as Gerdy’s Tubercle.
The classic symptoms of ITBS are pain along the lateral (outside) aspect of the knee joint, sometimes accompanied by a clicking sensation. The click is a result of the ITB tightening and snapping across the joint during running. The symptoms are often worse when running up or down hills.
ITBS is typically progressive, starting with tightness and often advancing to the point where the pain is debilitating. The traditional view on the cause of this injury has focused on the tightness of the structure and overtraining. There is no doubt that the ITB will become tighter when it is injured. The tightness, however, is more than likely a result of the injury and not the actual cause. The cause of this injury actually lies in the function of the ITB.
The main functions of the ITB are to assist the hip muscles in abduction (outward movement) of the thigh and to stabilize the lateral side of the knee. The ITB is not a strong structure, and if the surrounding muscles have any weakness that can lead to injury and ITB syndrome. Runners are notoriously weak in their hip and core muscles, particularly if strength training or participation in sports that involve side-to-side movement are lacking.
In a study published in the Clinical Journal of Sports Medicine (July 2000), Dr. Michael Fredericson, a physical medicine MD at Stanford University, compared 24 runners with ITB syndrome with 30 healthy runners and found the injured runners to have statistically significantly weaker hip abductors (mainly gluteus medius and minimus) than the non-injured runners.