Sarah, one of the runners that I coach, had been suffering from ITB (iliotibial band) pain, which was preventing her from doing any running. To alleviate the pain, she had purchased an over the counter knee strap to be worn while running. In addition, her physical therapist had prescribed a heel lift to correct a minor leg length discrepancy. Her ITB symptoms decreased in severity, but two weeks later, she began experiencing knee pain in the same leg. Understandably frustrated, she asked me if I thought that her new knee pain was somehow related to her ITB treatment.
To quote the old gospel song, “Dry Bones”:Skeleton Leg
Your foot bone connected to your ankle bone Your ankle bone connected to your leg bone Your leg bone connected to your knee bone Your knee bone connected to your thigh bone……..
Those in the health and fitness profession may prefer to state the same sentiment by describing the body as a kinetic chain. Modifying one link of the kinetic chain (i.e. body part) will have ramifications on other related parts of the body. In Sarah’s situation, the knee strap and heel lift alleviated her ITB pain symptoms but appeared to have caused her new knee pain. Most importantly, the knee strap and heel lift did not address the cause of her ITB pain, which is poor running-specific strength.
Cause of ITB Pain
Owen Anderson, Ph.D., is a leading exercise physiologist and researcher in training, sports nutrition and injury prevention. He states: “The ITB works eccentrically (attempts to contract while increasing in length) to prevent the thigh from moving inward when the foot is on the ground during the stance phase of gait. When it does so, the ITB is stretched out, because some adduction (inward movement of the thigh) must inevitably occur. The ITB is also active, because it must try to limit adduction. And so the action is eccentric – the poor ITB is trying to contract but is stretched out nonetheless.
What about the connection between that rubbing action of the ITB on the femoral projection and this eccentric activity? If the ITB is weak, it permits greater adduction (inward movement of the thigh) during stance. That stretches the ITB, puts it under greater tension, and presses it down on the femoral projection.” (The bracketed sections are my explanatory notes — don’t worry if the above explanation is not crystal clear). In summary,
Weakness of the ITB is the main cause of ITB Syndrome (ITBS)
Why Conventional Treatment Does Not Work
Conventional treatment of ITBS consists of stretching exercises and performing hip abduction strengthening exercises, either on a hip machine or lying prone and using ankle weights. I know from first-hand experience that neither is effective in eliminating ITB pain. I suffered through four years of ITBS before I started performing ITB strengthening exercises for eccentric movement (i.e. exercises that were running-specific).
Dr. Anderson: “What we have learned from a couple of decades of scientific research is that strengthening exercises must be specific to a particular movement, in terms of muscle-activation pattern, neural control, joint range of motion, and velocity, in order for that movement to be actually fortified. As many experts have pointed out, the desired goal is to strengthen movements, not individual muscles.”
Effective Treatment of ITBS
So, what exercise can you perform to develop running-specific ITB strength and thus eliminate or prevent ITBS? The “Frankenstein Marching with a Band” exercise, developed Karen Ward, an excellent and creative personal trainer in Atlanta. What equipment is required? Only a stretch band.