Iliotibial band impingement syndrome
The symptoms
Hip or knee pain, or both. Specifically, pain on the outer side of the knee where the bone bumps out above the joint, or on the outer side of the hip. The pain usually starts after 10 minutes of running. Walking usually causes no pain.
What’s going on?
The iliotibial band (ITB) is a thick tendon that runs along the outside of the thigh and connects the tensor fascia lata muscle – which starts on the outer side of the hip – to the outer side of the tibia, the major bone in your lower leg. So you’re talking about a tendon that stretches from your hip to your knee – that’s one long, important piece of tissue. It also crosses two joints, the hip and the knee, and helps control the angle of the lower leg while running. The ITB can also cause a pinching pain on the outside of the hip joint with trochanteric bursitis. In the knee, a tight ITB causes similar pinching.
Here’s how the pain happens: a small, fluid-filled sac called a bursa sits between the tendon and the outside of the femur near the knee. You also have a bursa at the hip joint. When the ITB is tight, it increases the tension on the outer sides of the hip and knee. The ITB then pinches these two sites and the bursa (one or both) swells. Over time, the bursa becomes enlarged – big enough to cause pain every time you begin to run (which is why pain usually starts within 10 minutes of activity).
Fix it
Stretch it: A tight ITB needs some love. There are many stretches for the ITB, though none of them are terrific. It’s a tough area to stretch because it covers so much distance. Try both of these to see which one brings you the best results. Figure-4 stretch: This targets the upper, more muscular half of the ITB. Lie on your back and cross one ankle over the other knee so your legs resemble the numeral 4. Pull the bent leg up towards your chest. You’ll feel the stretch in the outside of your hip. Hold for a few seconds and release. Repeat five times for both legs.
Roll it: A foam roller is the best tool for stretching the ITB. Lie on your side with the roller under your leg and roll it from your hip to your knee, using your body weight to knead the area. The pressure will help loosen the tendon and the fascia, almost like a self-massage. Do this at least once a day for several minutes, and make it a permanent part of your exercise routine.
Important: Rolling the ITB will probably hurt for the first couple of weeks. This is normal. Don’t stop. The pain is a signal that the ITB is tight and you need the treatment. As your ITB loosens, the pain gradually gets better. That’s a great sign of progress.
Beef up your glutes and hips: Weak bum and hip muscles contribute to ITB impingement syndrome. Make sure your lower-body work includes squats, especially single-leg squats, as well as some multidirectional lunges
(or the moves on the right).
Try orthotics: As is the case with many lower-body injuries, foot mechanics often play a role. A motion-control shoe along with over-the-counter arch supports can help tremendously.
Prevent it
Always remember: A strong behind is the key to a happy life. Weak glutes and hip muscles contribute to ITB impingement syndrome. A computer-driven lifestyle makes it easy for that area of your body to become deconditioned; the more you sit and stare at a screen, the weaker your glutes become, contributing to hip imbalances and instability. Build up your glutes and you reinforce the body’s largest and potentially most powerful muscle group. The stretches and exercises here all help build up your glutes and hip flexors and can be added to any workout.
HIP RAISE
Lie face up with your knees bent and your feet flat on the floor. Place your arms out to your sides at 45-degree angles, palms facing up. Raise your hips so your body forms a straight line from shoulders to knees. Squeeze your glutes as you raise your hips. Make sure you’re pushing with your heels. To make it easier, position your feet so that your toes rise off the floor. Pause for five seconds in the up position, then lower your body back down.
LATERAL BAND SIDE STEP
Place both legs between a resistance band and position the band just above your knees. Take small steps to your right for six metres. Then sidestep back to your left the same distance. That’s one set. Given the distance, it might be best done outdoors, so head to the park. If it’s too cold, take it indoors, but reduce the distances and multiply up the number or direction changes accordingly.
RESISTANCE BAND HIP ABDUCTION
Secure a resistance band to a sturdy object – a table leg, for example – then loop it around your left ankle. Start with your legs as close to each other as you can while keeping resistance on your working leg. Raise your left leg straight out to the side, as far as you can. Pause, then return to the starting position. Aim for 10 reps, then turn around and do the same number with your right leg.
LYING GLUTE STRETCH
Lie face up on the floor with your knees and hips bent. Cross your left leg over your right so that your left ankle sits across your right thigh. Grab your left knee with both hands and pull it towards the middle of your chest until you feel a comfortable stretch in your glutes. Hold for 30 secs, then repeat on the opposite side. Repeat twice for a total of three sets – and several times a day if you’re really tight.