Thoughts from the journey… Excerpts from a day in the life of Sherry McLaughlin

22Oct/093

Iliotibial Band Friction Syndrome

Iliotibial band friction syndrome is often described as an overuse injury that produces pain on the lateral knee. In fact, it is listed among the Big Five of running injuries, along with Achilles tendonitis, chondromalacia, plantar fasciitis and shin splints.

Unfortunately, it is also often misunderstood.

For instance, the quick fix for this injury (and many of the others in the list) is simply to stop running for awhile. Just rest the area and let it recover. The premise is that running, in and of itself, created the problem.

But the question that really needs to be asked is, how come the other knee isn't hurting if both legs ran the same mileage? Is it simply a cause of overuse?

Yes and no. Running isn't bad for you. Bad running is bad for you.

The most common scenario that causes ITBFS is a limb that won't pronate. Under pronation. You won't see that too much in the literature.

The normal gait pattern is such that heel strike is designed to occur on the lateral (outside) of your heel with pronation occurring for 25% of the stance phase. This act of pronation not only acts as a shock absorbing mechanism, but also transfers the force to the thicker and larger structures of the medial knee.

Someone so spends more than 25% of stance phase in supination is going to make the ITB very angry. After all, it isn't designed to have to cushion the blow of force dissipation for such a long time.

Some common causes of a limb not pronating?

• Tight gluteus medius (lateral hip muscle) - See the photo? Can you do this move equally on both sides?

• A leg that feels too short (pelvic malalignment, quadratus lumborum or iliopsoas trigger points)

• A subtalar joint that won't evert (Is there a history of ankle sprains in the past?)

• A tight lateral hamstring (Does the revolving triangle in yoga class make you fall over?!?)

• And... a shoe that offers too much support (Check to see if there is a gray bar on the medial side of your shoe last!) We are fans of neutral shoes for these folks.

The good news is... it's fixable! And it doesn't require tons of time away from running.

Oh, and by the way... if you understood what I just said, then you will realize that the ITB is overworked and overstretched in this scenario. Why on earth would you want to stretch an already over stretched muscle?

If you have this problem, or know of someone who does... do them a favor and look up at the hip and down at the subtalar joint. Fix that stuff and then send them back out on the road.

Until next time...

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  1. Thank you so much for inviting me to your blog! Keep up the awesome work… I love reading about it. OBLC is going well so far. It’s a lot to take in and they often forget many of us are brand new to Army life. I feel as though I am quite literally learning a whole new language and culture. Passed my first fitness test on Friday (yay!) Midterm exam is on the 30th, and we’ll be in the field for the three following weeks. I’ll send out another mass email soon… maybe with a few pics of my new apartment 🙂
    Oh, and keep an eye on the mail… I’ll be sending something your way this week.

    Take care!
    Casie

  2. After a lot of fruitless searching and a few unproductive physio consultations, it’s nice to come across this post on ITBS. Finally the pieces come together so that I can move forward to fix this nagging ailment. I’d like to share my story to support your statements and provide a case study.

    -I have a history of inverted ankle sprains, including one particularly bad sprain 13 years ago. As a result, I have limited dorsiflexion and eversion in my right ankle.

    -For at least the last few years, I have been wearing down the tread on the outside heal edge of my right shoe faster than the left.

    -I can’t squat properly, and when I do, my right knee collapses inward. If I force my knee to remain in the proper position, my right ankle slides inward during the squat.

    -Six months ago ITBS flared up in my right knee for the first time. There were a few coinciding events that I feel may have led to the the flare up, including the purchase a new pair of walking shoes with highly supportive insoles, as well as the purchase of my first pair of barefoot running shoes for hiking and jogging.

    -My current orthopedic specialist is not concerned with my ankle limitations and is instead focusing on treating my knee. I feel that unless I address my ankle, the ITBS will always be at risk of reoccurring.

    -I have started self-mobilizations for my ankle and stretches to improve my dorsiflexion and eversion.

    I am concerned that I may not be able to get the results necessary to improve my ankle mobility from these simple home exercises. Do you have any particular recommendations for a rehabilitation program? Are there any mobilizations or stretches I should focus on? If I need professional consultation, what type of specialist should I approach? I live in New Zealand so unfortunately I can’t come see you!

  3. I absolutely do have some suggestions for you! I will be sending you a complimentary copy of Wipe Out ITBFS program. In addition, I want to give you our Wipe Out Weak Gluteus Medius program.

    Thanks again for your comments on this blog. I hope we can help you get back to 100% ASAP.

    Sherry


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