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ILIOTIBIAL BAND SYNDROME: EXCERPT FROM RUNNING DOC’S GUIDE TO HEALTHY RUNNING
By Lewis G. Maharam, M.D.


SYMPTOMS: Pain on lateral side of knee or hip a mile or two into run. Never have pain from first step.
HOW IT OCCURRED: Friction of tight iliotibial band rubbing at hip and/or knee.
WHAT THE DOCTOR MAY DO: Palpate ITB. Gait analysis for overpronation. X-ray and MRI not needed.
GETTING BACK TO RUNNING: Stretching. Foam roller. “The Stick.” Orthotic or orthotic adjustment. If a small bursa has formed around Gerdy’s Tubercle, cortisone injection into the bursa. PRP if cortisone is ineffective. You can run through IT pain as long as it does not change your running form.
Note: Surgery should be last resort. In all my years of practice, I have seen only one case that required surgery to remove the bursa around Gerdy’s Tubercle.


Iliotibial band syndrome, also called ITB friction syndrome, inflicts sharp knee or hip pain on a wide range of sufferers: ballet dancers, football players, and—yes — runners and triathletes. Brought on by a sudden increase in training mileage or even a single unusually long workout, it’s nothing more than an irritation of a band of connective tissue that goes from the hip (the iliac crest) to the shin bone (the tibia). Hence, iliotibial.


The band could go about its business of stabilizing a runner’s foot during footstrike if only it didn’t have to pass over two impediments — a bony projection (called Gerdy’s tubercle) on the outside of your knee, and another diffuse bony protuberance (which has no name) on the hip — every time your leg is bent and straightened again. Loose ITBs slide harmlessly past the two obstructions. Tight ones rub against them, get irritated, and react with a sharp pain on the outside of the knee or hip that usually does not become bothersome until a couple of miles into your workout.


In the spring, my waiting room fills with suddenly ambitious spring trainers who find, practically overnight, that they can’t run very far. They’ve taken a few days off, to no avail. They’ve switched to their bicycles but gotten no relief (they’re feeling the same rubbing during cycling).


Simple stretching will work wonders, and that’s all the injury usually requires. Whether you were born with an abnormally tight ITB or stiffened it with exercise, the key to a cure is to get some slack back into it. Then it won’t rub.


STRETCHING A TIGHT ILIOTIBIAL BAND


FIGURE I ITB primary stretch. Lie on your back, bring your left knee to your shoulder, and push your knee over to the right shoulder with the palm of your left hand. Hold for 20 seconds, and repeat five times. Then do your right knee. Perform three times each day and also before workouts.


FIGURE II ITB standing stretch. With your arm against a wall or pole, slowly stretch toward the wall or pole with the other arm supporting your trunk. Do this whenever you see a wall not doing anything.


FIGURE III Using a roller to stretch out the ITB. Lie sideways on the foam roller. Roll the ITB area back and forth to loosen it up.


FIGURE IV Using “The Stick” to stretch out the ITB. While comfortably seated, grab “The Stick” at each end and roll it back and forth over the ITB to loosen it.


Lewis G. Maharam, M.D., is one of the world’s most extensively credentialed and well known running health experts. Better known as Running Doc™, Maharam is the medical director of the Rock ‘n’ Roll Marathon series, former medical director of the New York Road Runners Club and the New York City Marathon, and former columnist for Runner’s World magazine. This article was adapted from the new book Running Doc’s Guide to Healthy Running with permission of VeloPress. Download a free sample and preview the contents at velopress.com/runningdoc.


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