Yudu - sportEX medicine - 1999-2010

PATIENT ADVICE Iliotibial band syndrome

YOUR INJURY The iliotibial band (ITB) is a strong band running on the outside of the leg from your hip to your knee. When it is tight it can rub over a knobble of bone on the outside of the hip and one on the outside of the knee. Over time, this rubbing causes friction, swelling (inflammation) and pain. The condition is an overuse injury meaning that a very small stress is repeated over and over again. The key to beating the injury is to remove the cause rather than simply to treat the symptoms of pain.

Common causes include: (i) lack of flexibility in the ITB (ii) altered muscle control of the outside hip muscles (abductors) (iii) the way your foot and leg are aligned when you exercise.

STRETCHING EXERCISES To stretch the ITB properly you must move the hip while keeping the pelvis (hip bones) still. Lie on your side with the injured leg on top. Lift your injured leg upwards keeping it in line with your body (don’t take it forwards or backwards). Keeping your leg lift- ed, press the side of your waist against the floor. With your waist in contact with the floor, gradually lower your injured leg taking it down and slightly backwards. When you get to a point where the leg won’t lower any further, allow it to hang in the stretched position for 30-50 seconds, breathing normally. IMPORTANT NOTE: The stretch will be released if you allow your waist to lift from the floor and your pelvis to tip sideways.

FOOT AND LEG ALIGNMENT EXERCISE One of the causes of ITB syndrome is a change in the way your foot and leg are aligned. A tendency to allow your foot to flatten too much, pulls your knee inwards into a knock knee position and places stress on the hip. You must practice alignment exercise as well as the stretching and strengthening exercises above to have the best chance of recovery.

Begin standing on your injured leg with your foot on a thick book such as a telephone directory. Hold onto the back of a chair for balance. Take your weight over the outer edge of your foot by pressing your knee out- wards. When you look downwards, your kneecap should be over the lit- tle toe side of your foot.

Hitch your hip on the good side so that your hip bone on the good side is slightly higher than the one on your injured side and keep this hitched position for the rest of the exercise. Bend the knee of your injured leg slightly to perform a ‘mini-squat’ until the heel of your good leg touches the ground.

Perform 5-8 reps of this movement slowly, keeping: (i) your weight over the outside of your foot (ii) your knee press outwards (iii) your hip hitched.

STRENGTHEN CONTROL OF THE HIP To take some of the stress off your injured ITB, you must re- strengthen the muscle which supports the hip as you stand, the gluteus medius. Lie on the floor with your injured side on top. Your hips and knees should be bent, and your feet together. Keeping your feet together, lift your upper knee like a hinge with- out allowing your body to roll.

Lift the knee as high as you can and hold the high position for 20-30 seconds. Lower the knee and repeat for 5-8 repetitions. You may only be able to lift your knee a small amount, but with prac- tice you will be able to lift higher and higher as the muscle becomes stronger.

PREPARING FOR SPORT ITB syndrome is normally made worse by downhill movements, especially towards the end of a workout. Before you can return to sport therefore you must be sure that these movements can be performed without pain developing. The key is to develop ‘pos- tural endurance’, that is the ability to maintain leg and foot align- ment over a long period.

Using the alignment and control you developed using the ‘mini squat’ exercise above, perform controlled slope walking forwards and sideways. Choose a slope or ramp to train on. Car park ramps can be good, as can hills and driveways. Begin by jogging down the ramp and then walking back up. Emphasise your alignment as you did with the mini squat, avoiding the knock knee position, not allowing the hip to dip down.

Build up the repetitions starting with 3-5 runs and extending this to 8-10. Once this can be performed painlessly, progress to side walking and jogging. Use the injured leg as the downhill side and side step at a walking and then jogging pace down the ramp, turning to walk back up to the top normally. Build the reps from 3-5 up to 8-10 once more.

The information contained in this article is intended as general guidance and information only and should not be relied upon as a basis for planning individual medical care or as a substitute for special- ist medical advice in each individual case. To the extent permissable by law, the publisher, editors and contributors accept no liability for any loss, injury or damage howsoever incurred (including negli- gence) as a consequence, whether directly or indirectly, of the use of any person of the contents of this article.