Jill Murphy, DPT, LAT, CSCS
Despite the unfriendly outdoor weather so far this year, springtime is the season when many people are gearing up for participating in their first racing events of the year. This month is as good as any to begin our new series addressing common running injuries and more importantly, how to prevent them.
This month the focus is on the seemingly minor, yet agonizing painful phenomenon of iliotibial (IT) band tendonitis. The IT band is a long, broad, and fibrous band of connective tissue that runs from the tensor fascia lata muscle located near the top of the lateral hip to the lateral knee crossing over the lateral epicondyle of femur and attaching to Gerdy’s tubercle at the top of the lateral tibia.
While this thick, cartilaginous tissue can become very tight and irritated, it is not technically the fault of the muscle itself. The IT band is a very common compensation muscle/tendon that runners’ unknowingly utilize when they have muscles elsewhere not pulling their weight during strenuous activities such as running. The most common weak muscles to blame are the gluteus medius located in the back and outside of the hip and the quadriceps muscle at the front of the thigh. When both or either the gluteus medius and the quad are not capable of stabilizing the knee, and the IT band becomes too tired to resist, the knee begins to deviate medially (inward) with each running step as a runner fatigues. This excess movement medially strains the lowest portion of the IT band as it attaches to the tibia. The result is excruciatingly sharp pain in the lateral knee with each step. This pain is made worse with going up and down stairs, and can be replicated by placing pressure over the lower IT band as it crosses over the lateral knee while bending and straightening the knee past 30 degrees.
The solution for IT band tendonitis is rest, ice cup massage for 10 minutes over the painful area several times per day and after running or other activity. IT band stretching is also beneficial. When getting back into training, avoid hills as much as possible early on, as well as steps and curbs to avoid over-stressing the IT band. It will be important though, if planning to run a hilly race, to get back to some hill training prior to the event to adequately prep the IT band for this stress. Finally, some targeted gluteus medius and quad strengthening is critical to prevent this injury from re-occurring. See the article Build a Better Body, Part I Hips for a gluteus medius strengthening exercise. Any basic quad strengthening exercise will work as long as you avoid a knee extension machine in a fitness center. Choose instead a quad strengthening exercise such as squats and lunges progressing to single leg squats (with perfect form!) where your foot is on the floor, versus any quad strengthening with your foot in the air to protect your knee joint from excess stress.
Sidelying Rectus Femoris and IT Band Stretch
1. Lay on your side, bend your knee, and grab the top leg at the lower leg just above the ankle with your hand.
2. Pull your leg straight back with your hand until you feel a stretch at the front of your thigh. DO NOT pull your ankle to your butt, as this needlessly stresses your knee.
3. Place the foot of your bottom leg on the thigh just above the knee of the upper leg, and push down with your foot until you feel a stretch in your outer thigh of the top leg. Be sure to keep your hip from dropping toward the floor, as this may cause you to lose your stretch.
4. Hold the stretch for 30 seconds.
5. Repeat on the opposite side.
6. Perform 2x/day on each leg.