The warm weather season is finally upon us. This is the time of year when we start preparing to present our summer beach bodies and shed our winter stay inside bodies. This means eating healthier and getting more exercise. We dust off our bikes and dig our running shoes out from the back of the closet and set off on a journey to a healthier, better looking self. We need to exercise caution and ease into these things but sometimes we forget that we are mere mortals and push ourselves and our bodies to the limits. For long distance runners, this could mean a number of maladies. Long distance runners suffer blisters on our feet, chafing of the thighs, sore and achy muscles, or worse. One of the more prominent injuries that runners sustain is ITB Friction Syndrome. IT What? The ITB is not the Italian Transit Bureau or the Irish version of KGB. It is the Iliotibial Band sometimes referred to as the Iliotibial tract.
The ITB is a dense fibrous band of tissue that stretches from our hip alongside the outside of our legs to the knee. Not a muscle but a long band that extends from the ASIS (the frontal hip bone) and the Tensor Fascia Lata or TFL for short and you want to avoid sounding like you are ordering the latest trendy drink at Starbucks. The ITB is superficial or on top of the most outside muscle of the four muscles that make up our quadriceps muscles or the quads as you have probably heard them called in a gym. The band runs along the side of our leg and inserts onto the lateral condyle of the Tibia. Along with the Gluteus Maximus ("the butt muscle") the ITB is a knee stabilizer. When the knee is extended, the ITB is in situated in front that big bump on the outside of the knee just above the patella or knee cap (the lateral femoral condyle). When the knee is flexed 30 degrees or more the ITB finds itself behind the lateral femoral condyle. So as you can imagine, repetitive flexing and extending the knee as runners, cyclists, and other athletes do as well as anyone who walks up or down stairs, the passing back and forth of the ITB rubs the condyle and friction results. Hence the name, ITB Friction Syndrome!
ITBFS is an overuse injury that affects men and women equally, though women have a slight disadvantage due to gender anatomical predispositions of the thigh and knee resulting in other conditions such as knock knees and internal tibial rotation. It affects mostly 15 to 50 year olds, read: active runners. The increased tension of the band results in increased irritation and swelling results as does outside knee pain. Pain is sometimes found at the hip bone on the side of the leg as well. The pain is light at first but worsens with activity. As previously mentioned, runners are more susceptible to ITBFS and it is likely to affect long distance runners more than short distance runners as the stance phase of running is utilized more by the former causing more tension to the band. Sometimes you may hear a popping noise as the band passes over the condyle. In addition to runners or cyclists, people with pronated feet or feet that are turned inward are susceptible to ITBFS as are people with weak hip abductors like the gluteus medius and TFL. These are the muscles that allow you to lift your leg to your side and if these muscles are weak, the ITB and TFL take on higher forces.
Massage Therapy is very effective at treating ITBFS and secondary conditions as a result of tight ITBs such as low back pain and sacroiliac joint hypermobility. The primary goal of treatment is to reduce the tightness of the fascia and treat any trigger points that may be referring pain to the hip or the knee. Massage Therapy will also address any facial restrictions and adhesions and reduce any swelling that is present with manual lymphatic drainage techniques and hydrotherapy or ice. Finally, passively stretching any shortened muscles will help reduce or eliminate ITBFS symptoms. Using a foam roller between treatments is a great way to keep those muscles loose and stretched as well. So as you are working yourself into shape this spring, eat well and take in plenty of fluids and remember if anything starts to hurt, stop the activity and seek rest or treatment or both. See you at the races!
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