By Brittany Endres, PT, DPT, Results Physiotherapy
It is that time of year again. Winter is winding down and runners are hitting the pavement and trails, many of them in preparation for upcoming races. Injuries and pain with running typically come on with a significant increase in training.
Over the past decade, the popularity of running marathons, half marathons and 5k’s has greatly increased. Running is known to have a positive influence on a person’s physical fitness, as well as reducing chronic health problems such as the incidence of obesity and cardiovascular disease. However, running may also cause injuries, especially to the lower extremities. Iliotibial band syndrome or ITB syndrome is the second most common cause of pain of the knee in runners.
What are the common symptoms of ITB syndrome?
This condition almost always presents as pain on the lateral or outside part of the knee and sometimes in the lateral thigh. It is often described as tight, inflamed, stiff or achy. It is usually worse with repetitive activity such as running or cycling.
What are the causes of ITB syndrome?
The ITB becomes painful after repetitive friction of the iliotibial tendon on the outside of the knee. Training factors such as increased mileage, running one direction around a track or loop, on a sloped surface, and downhill running can influence the friction and stress on the ITB. Studies have also shown that lateral gluteal (hip abductor) strength has a significant influence on the ITB during running. The ITB is a common structure to compensate for weak gluteals, in an effort to create stability around the hip and pelvis.
What treatments are available for ITB syndrome?
Physical Therapy treatment involves identifying what are the contributing factors and addressing these through corrective exercises, manual therapy, and orthotics. Specific deep tissue mobilization to the ITB and hip muscles help relieve the stress at these sites. Specific strengthening and re-education of the hip muscles, specifically the gluteals has been found to significantly reduce stress on the knee by controlling excessive motion of the thigh and limiting the work done by the ITB. Flexibility exercises of the hip flexors and hamstrings have been shown to be beneficial in reducing the over-activity of the ITB as well. Orthotics or changes in footwear are occasionally utilized to help stabilize the foot or allow improved shock absorption with running.
A study in the Clinical Journal of Sports Medicine demonstrated the relationship between lateral gluteal (hip abductor) strength and Iliotibial Band Syndrome (ITBS). Researchers took 24 distance runners with ITBS and compared them to a control group (no symptoms). The injured group demonstrated about a 20% decrease in hip abduction strength on the injured side compared to the non-injured side. A six-week hip rehabilitation program with strengthening exercises focusing specifically on gluteus medius strengthening was performed by the injured group. After rehabilitation there was a significant increase in strength and 22 of 24 of the runners were able to resume regular running without symptoms and at six months had no reports of reoccurrence of symptoms.
Physical therapy with a focus of “Hands-On” manual therapy is an optimal treatment for ITB syndrome. At Results Physiotherapy every therapist has been through specific training in the treatment of ITB syndrome. It is also important to find a therapist who understands running injuries and Results has established a reputation of expertise in running.
If you have been experiencing knee pain that has been unsuccessfully treated by medication or are only getting temporary relief it is time that you called to schedule an appointment for an evaluation. This will prevent your condition becoming chronic and threatening your training program. Most insurances do not require a referral from a physician for physical therapy.
For a complete list of locations and information regarding Results Physiotherapy Centers, visit www.resultsphysiotherapy.com, www.facebook.com/resultsphysiotherapy, or call (615) 373-1350 / (800) 888-0531.