ITB FRICTION SYNDROME / ITB PAIN & RUNNING
The ITB is a fibrous connective tissue thickening called fascia. It originates on our ilium (pelvis) from two muscles – the gluteus maximus and tensor facia lata (TFL). From here the two muscles converge to create a wide strip of connective tissue providing support to our hip. As we get closer towards our knee the ITB narrows and becomes increasingly thick and fibrous crossing the outside of the knee joint (just above the knee it is easily felt) to attach into our tibia, hence the name ITB. The main function of the ITB is to help contribute to hip and knee stability when we are on one leg such as when running.
Pain associated with the ITB is most commonly experienced distally, towards its insertion lateral to the knee. Pain and discomfort is usually the result of repeated compressive loading and rubbing/friction of the ITB against a bony landmark on the femur called the lateral femoral epicondyle.
As with almost all injuries it’s easy to get distracted by the symptom source of the pain. But…we need to hunt the cause. So, what causes ITB pain?
In short. Biomechanics. ITB tension and compression of underlying tissue will occur when the origin and insertion of your ITB are moved further apart. When we look at running; gluteal strength, motor patterning and running technique are the primary things to consider.
Cross-over gait is a commonly seen gait pattern amongst the running population. It occurs when there is an increase in hip adduction during late swing and a contralateral pelvic drop during stance phase. So…we see a pelvic drop on the leg your standing on and as a result the leg swinging through crosses towards midline. The result of this is a significant reduction in step width; and as your swing leg crosses midline, the origin and insertion of your ITB will be moved apart, increasing tension and the potential for ITB symptoms.
An article by Meardon et al. in 2012 concluded that relatively small decreases in step width can substantially increase ITB strain. Unfortunately changing running technique isn’t easy. It’s not as simple as running with a wider step. It requires a combination of improved strength (incl: gluteals, lower abdominals, obliques) and motor patterning, along with an awareness of body position.
As mentioned in the previous post “Running Injuries #1: Stress Fractures” we can have both intrinsic and extrinsic factors that can predispose us to injury. When considering ITB complaints; Intrinsic factors include: poor biomechanics, altered running gait pattern, poor lumbo-pelvic control, reduced strength etc.; Extrinsic factors include: training load, training surface, shoes etc.
In most instances ITB problems can be easily managed and prevented from re-occurring by addressing both intrinsic and extrinsic factors that have resulted in an injury.
A lot of the time running load doesn’t need to be ceased, just modified while the causes are addressed.
If you have any questions concerning ITB pain or are in need of advice, please don’t hesitate to call or email: (03) 5229 3911 or firstname.lastname@example.org.
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Meardon SA, Campbell S, Derrick TR. 2012. Step width alters iliotibial band strain during running. Sports Biomechanics. 11(4), 464-472