I've enjoyed running for a long time now. I've run for sport, fitness, meditation, commuting, and definitely free food. As much as I enjoyed it, I remember having some serious knee pain in high school while going for distance (5+ mi) runs. I was young and getting into the best shape of my life, how was this possible? While I did not pay it much attention then, I really started showing interest when I began coaching Track and Field in 2012. I found myself trying to manage the aches and pains of my high school athletes every year. What are these injuries, why were they happening, how could I alleviate them or better yet help prevent them?
I think it’s safe to assume, since you're reading this article, that perhaps you have similar questions. After a few more years of coaching, earning my Doctorate in Physical Therapy, along with my CSCS and USATF Level 2 Certification I've learned injuries are quite common in running. They can happen to anyone, regardless of athletic level or age. Running is a very strenuous task on the body which places significant strain throughout your entire musculoskeletal system. So should we abandon running and opt for cycling or swimming instead? Best universal answer I can give is this: it depends. A lot of these issues can often be corrected or at least managed and your commitment will play a major role in this answer.
You're looking for answers so we know you’re on the right track. However, as one of my childhood idols, Bruce Lee, stated “Knowing is not enough, we must apply. Willing is not enough; we must do.”. Over the next few weeks I hope to cover some of the more common running injuries, what often causes them, and a good start to both recovery and prevention.
For today we will cover:
Iliotibial (IT) Band Syndrome
The IT Band is a thick strip of connective tissue called fascia, originating from the hip, mostly Tensor Fascia Lata (TFL) and some contribution from the Gluteus Maximus. It then passes over the lateral side of the knee and inserts onto the lateral condyle of the tibia (Gerdy’s tubercle). The IT band helps stabilize the hip and knee during the stance phase.
IT Band syndrome is an overuse inflammatory injury which presents with pain along the lateral knee although can sometimes be felt further up the thigh. It was previously believed to occur due to repetitive snapping of the band over the lateral femoral condyle at around 30 degrees of knee flexion. As we run, our knees are constantly flexing and extending through this point. During stance phase, when we are relying on the IT band for stability, our knees move through 0 - 55 degrees of flexion. However, the snapping appears to be more of a Houdini-like illusion made by tightening and loosening of the anterior and posterior portions of the band. This new information simply points out irritation is occurring via compression of the IT band and deeper structures rather than snapping.
So lets run with less knee flexion, right? Not quite. Reduced knee flexion would hinder our ability to dissipate forces and can lead to other pathologies such as stress fractures. What we need to consider are the following: Hip Abductor and External Rotator weakness seem to play a large role in the development of IT Band Syndrome. During the stance phase of running, internal rotation of the hip due to these deficits allows various structures including the IT-Band to become compressed. This internally rotated position also places greater demand on the TFL, rather than glutes, which further compresses the IT-Band. Too narrow a step width, cross-over gait, can also replicate this compression. Other characteristics such as over-pronation have also been identified as potential risk factors.
Icing, rest, foam rolling, etc. are good starts but are more for management of symptoms rather than correction of problems. If you want to increase your chances of preventing these injuries you'll have to attack the root cause such as training errors, biomechanics, and deficits in stabilizing muscular. When starting out keep it simple and consistent. Back off from running for 2-3 days and begin performing some corrective exercises. Start off with 1 set of 15 repetitions and build your way up to 3 sets of 30 repetitions over 6 weeks. Exercises such as side-lying hip abduction, standing hip hikes, side-lying hip external/internal rotation, clam-shells, and bridge variations are excellent corrective exercises to incorporate into your routine. Follow my instagram account #breakoutppt for videos. When you return to running decrease mileage initially and work your way back up. Fascia has limited elasticity and therefore stretching of the IT band is only minimally effective, instead stretching should target associated musculature.
Consultation with health care providers such as your physical therapist is recommended. Your therapist will be able to identify issues in your training programs and/or biomechanics and provide appropriate feedback. They can also assist perform more aggressive tissue manipulation techniques such as Active Release Techniques (A.R.T.) and Instrument Assisted Soft Tissue Mobilization (IASTM). Next week we will cover Achilles Tendinopathy and Plantar Fasciitis.