ITBS remains one of the main causes of knee pain in runners. Use this three-phase treatment plan to reduce inflammation and strengthen the area in question.
Phase 1: REDUCE PAIN AND INFLAMMATION
The initial phase focuses on reducing pain and inflammation and increasing mobilization of the ITB. Rest, ice, NSAIDs and topical anti-inflammatories are all effective in this initial phase. Occasionally, a corticosteroid injection can help–when used judiciously with the understanding that the injection is not curing the injury–to reduce the pain and enable one to move on to the next phase.
Phase 2: MASSAGE AND STRETCHING
Treatment progresses by using deep-tissue massage, a necessary step before moving on to strengthening. Fadil recommends frequent massage: every day for elites and two or three times per week for recreational runners. If you cannot afford the expense or time of going to a certified massage therapist, a foam roller can work well for self-massage, or a tool such as the ROLL Recovery R8 or the Stick. (Roll all the way from knee to hip.) Maintain fitness with cross-training that does not aggravate the condition. (If it hurts, try something else.) After the pain subsides, add stretching while continuing deep tissue massage.
Phase 3: STRENGTHENING
Begin strengthening as soon as the exercises below can be performed painlessly. If you have access to an AlterG treadmill, that may also allow continued running during the rehabilitation phase.
The most effective lengthening exercise for the ITB is to stretch it across the hip and outside of the leg. Cross the injured leg behind the other leg and lean toward the uninjured side. First stretch with your arms over your head, creating the shape of a bow from ankle to hand with the injured ITB outside, then bring your arms down to touch the ankle on the inside of the bow. The runner’s right leg is being stretched in image above. Hold the pose for 15 seconds and repeat 10 times. Perform three sets a day.
A. CLAM SHELL
Begin with a clamshell exercise using a resistance band. Perform the exercise slowly with emphasis on good form. Build up to 10 repetitions of three sets on each leg. When this exercise becomes easier and the leg remains pain-free during the process, you can move on to more advanced strengthening.
B. SIDE LEG LIFTS
Lying on your side, raise your top leg straight up, then pull the leg back in that plane, move it forward and return it to the starting position. Form is very important. Check that you have a straight line from shoulder to ankle with the top hip slightly in front. (Do not let the top hip rotate backward.) Perform the sequence slowly with toe pointed down. Build up to three sets of 10 repetitions for each leg.
C. SINGLE-LEG SQUATS
Balance on one foot, then bend your supporting knee to lower your torso one-quarter of the way to the ground. Take care that the knee stays straight over the foot and does not collapse inward.
After you have mastered the straight quarter squat, make the exercise more challenging by mimicking running form, extending the unsupported leg behind you and bringing it through to lift the knee in front of you. Ultimately, move farther by touching the ground in front of your body on the forward lean.
While standing on your right foot, move a soccer ball up and down diagonally from lower left to upper right, then side to side in a twisting motion. Repeat with the left foot, moving the ball from lower right to upper left.
D. HIP HIKES
When strong enough, eccentric strengthening works the hip abductors in the same manner in which they function during running. Standing on one foot on a step or a stair, raise the other foot by lifting your hip on that side, while taking care to stay in a straight, upright position. Slowly lower the hip to the bottom of your range of motion, while staying upright. Perform 10 repetitions on each side and build up to three sets.
As you get stronger and your ITBS symptoms subside, test the injured leg with short runs that can be extended as long as the pain is not causing a limp or any compensation. Strides can sometimes be performed early in the treatment phase–shorter and faster running often does not make the injury worse. Recovery time depends on many factors such as the length of time you have been injured and biomechanical aspects of your stride. Continue strengthening after you have resumed training to prevent further episodes of ITBS.
IMAGES BY MITCH MANDEL