The knee pain that
won't quit
Iliotibial band
syndrome is a common overuse injury that causes severe knee pain, and can be
difficult to cure.
Most non-runners have
never heard of the iliotibial band: a stabilizing fascia on the outside of the
leg that connects at the hip and below the kneecap. It's purpose is to
stabilize the leg when the quadriceps, the big muscles on the front of the
thigh, fatigue.
The quadriceps are the
muscles distance runners use the most: together with the hamstrings, they
comprise the 'primary movers.' The cumulative effect of long slow mileage is a
shortening and weakening of the quadriceps. When the quads weaken, the IT bands
prevent excessive side-to-side leg motion that could damage the knees and hips.
The problem with
diagnosing and treating IT band syndrome is that symptoms only appear after the
injury becomes serious. Though tight, sore quadriceps are easy to feel,
tightening of the IT bands can occur with no pain or noticeable loss of
flexibility.
The runner's first
inkling of a problem is severe pain at the attachment points, that typically
occurs several miles into a run. The pain, which the runner feels either at the
side of the hip or lateral side of the kneecap, can go away for a period of
time, only to reappear days, weeks or months later.
Compounding the problem
is the fact that IT band syndrome has a variety of causes, ranging from
overpronation or underpronation, leg length discrepancies, muscle imbalances,
an excessive Q-angle, tight hip flexor, gluteal or quadricep muscles, or a
combination thereof.
It all starts with the
feet
Most specialists agree
that IT band injuries begin with the feet. When a runner's feet roll
excessively inward or outward during the gait cycle, it places more stress on
the IT bands, causing them to tighten.
Not all running shoes
are created equal: good ones are the runner's first line of defense against
iliotibial band syndrome. Specialty running shops offer gait analysis, to
assess how much support a given runner needs.
There are three
categories of shoes, ranging from motion control models that correct for severe
overpronation, to neutral cushioned shoes for runners who underpronate or have
a neutral gait pattern. Many runners wear stability shoes, which provide a
moderate amount of arch support.
Sometimes the feet act
differently: one may overpronate, and the other not. Leg length discrepancies,
pelvic rotation and muscle imbalances are among the culprits. Since shoes can't
correct for different gait patterns in the left and right foot, an orthotic
device in the shoe evens out the feet, so they function the same way.
Building a strong core
Core strength is key to
preventing IT band and other overuse injuries. When the quadriceps and
hamstrings fatigue, the runner's pelvic muscles take over to keep the legs
tracking straight.
While there's a lot of
good information on core strength training online and in print, it's helpful to
start with a specialist. An experienced coach, personal trainer or
physiotherapist can assess problem areas, and assign specific exercises to
strengthen the weak links.
Home remedies
The proactive measures
mentioned above slant the odds in one's favor, but they aren't bulletproof.
Iliotibial band injuries can strike the most cautious of runners, often at the
peak of their training, when they can least afford to take time off.
If an athlete catches
the injury early, it's possible to continue some training, and still allow it
to heal. Here's some pointers:
Run only on soft
surfaces such as packed dirt or grass. Avoid severe up or downhill grades. If
the surface is cambered, make sure to change sides of the road periodically.
Sometimes one side of a cambered surface will be less irritating to the injury
than the other.
Run to the point of
pain, but not through it. Since IT band pain typically comes on several miles
into the run, it's possible to run to that point without making the injury
worse. With treatment, the interval before the onset of pain will grow longer,
and the runner can gradually resume normal training.
Ice massage is the best
way to reduce the inflammation around the painful area. The easiest way to do
ice massage is to fill Dixie cups with water and freeze them: peel the paper
down gradually to expose a small area of ice and massage the sore spot for a
minimum of five minutes. Do the ice massage two-to-three times daily until the
pain subsides.
Some runners are
flexible enough to stretch the IT band, others are not. A good sports massage
specialist or physical therapist can promote healing by releasing tension in
the IT bands. Some runners find that rolling on a foam roller is effective in
reducing IT band tightness.
Professional treatment
If the pain doesn't
subside in a couple of weeks, it's best to seek professional treatment. Office
treatments not only reduce the painful symptoms of IT band syndrome: they also
expedite healing. Modalities that reduce inflammation include ultrasound, cold
laser, and electric therapy.
The Graston Technique
promotes healing by breaking up scar tissue that builds up around the injured
area, so the affected muscles, connective tissue and fascia can heal properly.
Therapists will
recommend a specific strengthening and stretching routine to help the muscles
resume normal function, and reduce the likelihood of a recurring injury.
More information on
musculoskeletal conditions, injuries, and treatments can be found at
http://www.robertsonfamilychiro.com
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