Wednesday, June 9, 2010

ITBS – from Ouch to Ooooo! – in plain English, Part I

The list of injuries you can incur whilst training for an ultramarathon is long and can be confusing with many different names, jargon and acronyms to deal with. ITBS (Iliotibial Band Syndrome) is one of them and there is a wealth of information available for diagnosis and treatment of the condition. There is a school of thought that if you have ITBS, then you can do little more than manage the condition, you have it for life, and really Ultra running is not a good sport for you to participate in. From my research and personal experience, I would like to offer a glimmer of hope from those who have suffered from ITBS.

So what is Iliotibial Band Syndrome? Put simply it is a pain on the outside edge of your knee which you usually get a few kms into a run, and it can be so severe as to cause you to stop running altogether. It is caused by the ITB (Iliotibial Band) rubbing against the nobbly bit of the lower thigh bone (the epicondyle of the femur). The ITB is a band of muscle and connective tissue that runs from the hip to top of the lower leg bone (the tibia). It is not attached to the thigh bone at all, and in effect helps keep the “knee bone connected to the thigh bone” and “the thigh bone connected to the hip bone”, now hear the word of the Lord!
As a result of this mechanical arrangement, every time you bend your leg past about 30 degrees, the ITB has to move over the top of the nobbly part of the femur. When you’re running the ITB is under tension, forcing it to rub against the bone, and that is where the pain comes from.

It’s quite easy to diagnose this by the standard accepted method of the “Nobel Compression Test”. You can try this on yourself, and perhaps save yourself some expensive Physiotherapy costs.

So once you have established that you have ITBS, you will want to know how you can get rid of it. The standard treatment for it is to stop running and stretch the ITB. It’s not the easiest part of the body to stretch and there are loads of versions of stretches you can use. Here is one option:

If this doesn’t work for you try other positions which create that stretching feeling down the outside of the thigh. The key thing I have found is to make sure you tilt the pelvis upwards on the offending leg.

Another suggested therapy is to use a foam roller on the ITB, and this is something I do quite regularly for prevention, or when I feel tightness in the ITB (typically in my first few runs after an ultra race). Simply lie on your side (the injured side), legs straight, with the foam roller under your knee. Then slowly roll you body down over the roller, supporting as much of your weight as possible on the roller.

The first time you do this it can be pretty painful, but each time it gets easier and after a few sessions you should be able to do this without any discomfort. Roll from the knee to the hip to complete the motion, and if you have any spots of stronger discomfort go over them again, perhaps more slowly.

These treatments will reduce any pain and allow the inflamed part of the ITB to recover. This is obviously a good thing, the problem is that the effects may not be lasting, and it does little to address the cause of the ITBS in the first place.

The causes of the problem can be mechanical (such as being Bow-legged), leg length discrepancies, excessive pronation or muscle tightness. There is no “wonder treatment” to cover all these, but one in particular, the “Walt Reyonld’s ITB Special, is highly effective, and it has been designed specifically for runners.

The Walt Reyonld’s ITB Special takes into account the specific stresses and strains put upon the joints, muscles and connective tissue that occur during the normal running cycle. The treatment improves the flexibility and the strength of the ITB, which provides resistance to injury.

In part two of this blog I will cover instructions on how to perform this exercise, and how you incorporate lessons from it into your daily routines to make you a stronger, more efficient runner.

For a more detailed (and more technical) look at the ITBS, I would recommend a book that I consider to be the runners’ bible – “The Lore of Running” by Tim Noakes. It’s an essential addition to your library if you take your running seriously. One of the best things about the book is that the author is not only a doctor, but also an experienced ultrarunner. He relates his text to many of his own experiences, backed up with masses of research.

Happy running,

“You only ever grow as a human being if you’re outside your comfort zone” – Percy Cerutty (Olympic running coach)


  1. Thanks Andy,

    ITB test is injury. Will have to give that a go. Mine is self-diagnosed but im pretty sure thats what i have. After hiking my running right up to TNF100 i have no doubt thats what caused it.

    An ITB strap just came in the post today. It wraps around your thigh and is meant to hold the ITB in place. Not able to run for a couple of days due to other committments but fingers crossed it will help

    Great to hear your will be at Glasshouse, will have to catch up then

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