ITB Syndrome

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   Our user asked: "I have logged over 1,000 miles in the past 3 years. I have never had knee pain. I did stress fracture my left tib. I took a year off for that to heal. I am training for my first 1/2 marathon. I run every other day, and do crossfit in between with 2 days a week rest. I have been running 7 miles on Tues, Thurs, with a 5k on Sat. I began to increase my mileage by 1 mile per month. 2 8 mile a week runs with a 5k, then 9 miles in Nov. December hits. 10 mile Dec. 8 miles into my first 10 mile run the knee pain hits...I use RICE, lay off for a week. Increased miles slowly again. I got 10 miles this Sat. 3/6, but at mile 8 the knee pain returned. I am using the Patt Strap, foam roller, stretches and Advil. If I have ITBS, why does it take 8 miles to start hurting? My marathon is in May. Any advise...training schedule? Anything? Taking the next week off, so will be sitting here sulking, waiting for reply. Thanks"

Ask a PT Response: "For ITB syndrome, runners usually develop the knee pain while into a run, because the ITB eventually becomes stressed as a result of overloading or because of biomechanical issues. With running, the ITB assists with controlling and decelerating adduction of the hip (eccentric control). When this function of the ITB becomes compromised as a result of overloading (ie. running on hard surfaces, increase intensity, increase duration, etc.) or becomes affected as a result of biomechanical issues (ie. muscle imbalance, structural deviations, poor running mechanincs, etc.) irritation of the ITB can occur. 

Sounds like you are taking the recommended steps for recovery from this condition with rest, ice, stretching, etc. The standard ITB stretching exercises are great but incorporating functional stretching of the ITB which simulates running should be implemented as well. One such stretch called is called "Walt Reynolds's ITB Special". Instruction on how to perform this stretch can be found on http://onemillionruns.blogspot.com/2006/10/walt-reynolds-itb-special.html. Another common occurence I see in some of my patients with ITB syndrome is weakness of the hips, particulary the gluteus maximus (hip extension) and medius (hip abduction). Weakness in these muscles could result in additional stresses to the ITB and knee. 

As far as returning back to running, I would gradually build back up to the 8 miles after resting and considering/implementing the various treatment options available to you and then adding on distance slowly from there. Definitely don't continue to push yourself past the pain should pain occur when running greater than 8 miles. It also may not be a bad idea to consult with a PT at this time as he or she may be able to determine what could be contributing to your ocurence of ITB syndrome and devlop a plan of care specific to your needs so that you can participate in the marathon in May. I hope this helps and I wish you the best of luck."

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Ask a PT Members Profile Send Private Message Find Members Posts Add to Buddy List Senior Member Joined: Jul 07 2008 Status: Offline Points: 954	Post Options Post Reply Quote Ask a PT Report Post Thanks(0) Quote Reply Topic: ITB Syndrome Posted: Mar 16 2010 at 4:24pm
	Our user asked: "I have logged over 1,000 miles in the past 3 years. I have never had knee pain. I did stress fracture my left tib. I took a year off for that to heal. I am training for my first 1/2 marathon. I run every other day, and do crossfit in between with 2 days a week rest. I have been running 7 miles on Tues, Thurs, with a 5k on Sat. I began to increase my mileage by 1 mile per month. 2 8 mile a week runs with a 5k, then 9 miles in Nov. December hits. 10 mile Dec. 8 miles into my first 10 mile run the knee pain hits...I use RICE, lay off for a week. Increased miles slowly again. I got 10 miles this Sat. 3/6, but at mile 8 the knee pain returned. I am using the Patt Strap, foam roller, stretches and Advil. If I have ITBS, why does it take 8 miles to start hurting? My marathon is in May. Any advise...training schedule? Anything? Taking the next week off, so will be sitting here sulking, waiting for reply. Thanks" Ask a PT Response: "For ITB syndrome, runners usually develop the knee pain while into a run, because the ITB eventually becomes stressed as a result of overloading or because of biomechanical issues. With running, the ITB assists with controlling and decelerating adduction of the hip (eccentric control). When this function of the ITB becomes compromised as a result of overloading (ie. running on hard surfaces, increase intensity, increase duration, etc.) or becomes affected as a result of biomechanical issues (ie. muscle imbalance, structural deviations, poor running mechanincs, etc.) irritation of the ITB can occur. Sounds like you are taking the recommended steps for recovery from this condition with rest, ice, stretching, etc. The standard ITB stretching exercises are great but incorporating functional stretching of the ITB which simulates running should be implemented as well. One such stretch called is called "Walt Reynolds's ITB Special". Instruction on how to perform this stretch can be found on http://onemillionruns.blogspot.com/2006/10/walt-reynolds-itb-special.html. Another common occurence I see in some of my patients with ITB syndrome is weakness of the hips, particulary the gluteus maximus (hip extension) and medius (hip abduction). Weakness in these muscles could result in additional stresses to the ITB and knee. As far as returning back to running, I would gradually build back up to the 8 miles after resting and considering/implementing the various treatment options available to you and then adding on distance slowly from there. Definitely don't continue to push yourself past the pain should pain occur when running greater than 8 miles. It also may not be a bad idea to consult with a PT at this time as he or she may be able to determine what could be contributing to your ocurence of ITB syndrome and devlop a plan of care specific to your needs so that you can participate in the marathon in May. I hope this helps and I wish you the best of luck."

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