Tuesday, May 27, 2008

Iliotibial Band Syndrome

This is a continuation of my previous post on running injuries.

I had ITBS a while back and got it again after a hiatus of about a month from running. It's a recurring problem for me, hence I have a separate post devoted to it.

As mentioned before, being one of the most common running injuries out there, there's tons of information out there on it. Not all of is clear though. Here's the low-down on ITBS that isn't that easily found out there on the Internet and tempered with my own personal experience. Most of the information in this post can be googled easily for clarification. As is often the case, once you have the name of what you're looking for, and the right specific question to ask, the information is easily found.

Don't confuse ITBS with patellar chondromalacia
ITBS for me always strikes on the lateral epicondyle. So the pain is localized to the knee. There's no pain but always some residual tightness all along the ITB from the knee up till the hip. For the longest time, I thought my knee problem had returned, but it wasn't until I read more extensively on ITBS that I realized that my knee problem really was an ITB problem. Apparently, Noble's test and Ober's test can be used to diagnose ITBS.

Stretching doesn't work for everyone
The conventional ITB stretch does exactly nothing for me, and I'm sure I'm doing it right. So don't put too much store by the ITB stretch, which is found and published all over. It may help in relieving symptoms and pain, but it doesn't address the real problems behind ITBS.

Strengthening the gluteus medius is key
I won't elaborate too much on this. One of the best papers I've read on this is by Fredericson et al ( Clin J Sport Med. 2000 Jul;10(3):169-75. Hip abductor weakness in distance runners with iliotibial band syndrome). Full text probably needs a subscription, but the abstract is available on Pubmed.

To completely prevent ITBS, the gluteus medius and other muscles for both legs must be strengthened and balanced. The clam shell exercise is good, as are side leg lifts (preferably done with the back against a wall and with the toes of the lifting leg pointed straight up to the ceiling). You must palpate your own gluteus medius muscle to check that it's actually working during these exercises. The body has a tendency to recruit stronger muscles like the vastus lateralis (part of the quadriceps) to compensate for the weaker muscles that you actually want to work. And always work both legs, not just the affected one. Balance is absolutely necessary.

There's something called 'Walt Reynold's ITB Special' that's a fancy pelvic drop exercise that may help. Other useful reading can be found here. If the descriptions for the exercises are too hard to follow, and the pictures too static, look for videos on Youtube.

On a sidenote, now that I do these exercises on a semi-regular basis, I have strange but painless popping sensations on my hips. Wonder if it has anything to do with this.

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