IT band syndrome treatment plan

Iliotibial band (IT band) syndrome is the most common cause of outer knee pain in runners. The iliotibial band is a thick band of fascia (tough, sinewy tissue) that runs along the outside of your thigh. It starts at the top of your pelvic bone and attaches to the outer side of your lower leg, just below your knee joint.IT band syndrome is an overuse injury that most commonly develops due to a sudden increase in running volume, frequency, or intensity.

• IT band syndrome pain is located over the outer side of the knee. It can be a sharp, achy, or burning pain. You will usually be able to reproduce your pain by pressing on the area.
• You may notice a bit of swelling and puffiness along the outside of your knee.
• You will only feel the pain during exercise or when you move, not at rest.
• IT band syndrome is an overuse injury that develops gradually during exercise and not due to sudden traumatic events, such as twisting your knee.
• The pain usually starts after you’ve run a certain amount and worsens as you continue running on it.
• Long runs, downhill running, or running on a camber aggravate it most.
• Common everyday activities that may hurt when you have IT band syndrome include walking down stairs or squatting down to the floor.

You should consult your doctor or physical therapist before using the app to ensure you have the correct diagnosis and are ready to start rehab exercises. If you have any concerns about your injury after you've started your rehab, schedule a review with your doctor, particularly if:

• You feel a sudden sharp pain in your knee while doing an activity - it may mean you've strained or torn something, and the program in the app may no longer be appropriate for you
• Any part of your leg (thigh, calf, or foot) is swollen, red, hot to touch, or throbs with pain - these signs can indicate a blood clot, which should be investigated as soon as possible
• You have pain at night that keeps you awake or interrupts your sleep
• You feel pins and needles or tingling in your leg - this can mean you’ve injured a nerve and our rehab plan may not suit you
• Your symptoms get worse
• Your injury does not recover as expected (see expected recovery times below)

Interestingly, research shows that in most IT band syndrome cases, it's not the IT band itself that becomes injured. Instead, the fat pad between the IT band and the bone becomes inflamed and painful.

The fat pad's role in this area is to protect the IT band as it compresses against the bones. But when there is excessive compression, the fat pad can be injured.

Experts theorize that the lower portion of the IT band can be excessively compressed in runners if their knee turns in excessively, or their hip adducts (move inward) excessively when they run. According to research, there’s no clear cause for IT band syndrome and several factors likely combine to cause the condition. Some of the most common risk factors for developing IT band syndrome include:

• Running on a camber
• Doing lots of downhill running
• Weak gluteal muscles, causing your leg to adduct and turn in excessively
• Excessive pronation at your foot or ankle, causing your knee to turn in excessively
• Shoes that are too flexible, encouraging excessive pronation
• Fatigue - when you push into fatigue, your muscles aren't able to control your legs properly - this can happen during a single hard running session or when you train on tired legs (due to not allowing full recovery between training sessions)

Clinicians initially thought that an overly tight IT band caused the injury because your IT band and leg muscles generally feel very tight when you have it. But now we know that the IT band itself can't contract, stretch, or become tight on its own. Rather, the muscles that attach to the IT band (glutes, tensor fasciae latae, outer quads) pull it taut when they contract.

Treatment

According to research, the current advice is that treatment for IT band syndrome should consist of 3 parts.1 - Initial pain and inflammation management to calm down the injured area. Treatments that can help with this include:

• Avoiding aggravating activities: This includes stopping running or significantly reducing your running volume for a while; the app contains articles explaining how to decide what activities are OK to continue and gives suggestions for keeping fit while recovering
• Taking anti-inflammatory medications (NSAIDs): A doctor should prescribe these for you
• Icing or cooling the injured area: The app provides detailed advice on using ice to decrease pain and inflammation
• Massaging or foam rolling the muscles attaching to the IT band: This can help reduce tension and pain, but be sure to avoid the injured area next to your knee; and refrain from using strong pressure, as it can make your injury feel worse
• Wearing supportive insoles: Runners who pronate excessively at their feet or ankles may benefit from using insoles - a podiatrist can assess if they will help you
• Using IT band straps or braces: There's currently no research showing these devices work
• Avoiding corticosteroid injections: Research shows they can reduce pain in the short term but may have detrimental effects on long-term recovery

2 - Rehab exercises (such as those in the app) to help with injury recovery and prevention. The exercises should start at a low intensity and gradually progress, finally restoring the strength you require for running. Types of exercises include those aimed at:

• Improving strength and control in the muscles that may have contributed to your injury (core, hips, ankles)
• Slowly restoring the strength of the injured tissue
• Stretching to reduce the tension in the muscles attached to the IT band

3 - A slow return to running, including adapting your running style to reduce the strain on your IT band. The app provides information on how to assess your running style, what risk factors to look out for, and how you can improve it.

Recovery times

Most cases of IT band syndrome recover within 6 to 12 weeks, but sometimes it can take longer. Your recovery time will depend on:

• The severity of your specific case
• How quickly you start the correct treatment plan
• Your body's ability to heal

Prevention

You can reduce your risk of developing IT band syndrome by:

• Avoiding sudden increases in training volume and intensity
• Varying your running surface and terrain
• Choosing running shoes that provide the appropriate level of support you need
• Maintaining a good baseline level of strength and flexibility in your body

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