Follow up to our last ITB article, we have identified three conditions that contributes to the tightening of the ITB. They are weak outer hip muscles, incorrect training methods and bio-mechanical gait issues. In this edition, we seek to address these three main problems, looking at strengthening those weak hip muscles, rectify those poor training methods and biomechanical issues, outlining the practical management of iliotibial band friction syndrome (ITBFS) associated with running athletes.
Weak outer hip muscles
Early stage of rehabilitation aims to redress muscle weakness in the hip which may be considered as a major factor in the development of this condition. Thus, strength and conditioning exercises should focus on the muscle called gluteus medius. The reason why we target the gluteus medius is because it functions as an important stabilizer to control and decelerate adduction of the thigh during running. Poor endurance and control of the gluteus medius leads to gait alteration and ultimately ITBFS. Furthermore, to decrease tension along the ITB, the use of a foam roll and performing isolated stretches for tight muscles can be particularly effective in releasing myofascial restrictions. Below are some recommended exercises.
Having re-established muscle balance around the hip, you should now be ready to take full bodyweight on the affected leg while maintaining optimal body alignment. To start getting back to running, we recommend running every other day for the first week, starting with easy sprints on level ground. It is important to note that studies have shown that ITBFS occurs mainly at, or at slightly less than, 30 degrees of knee flexion. Thus, it is necessary to avoid downhill running because the knee flexion angle at footstrike is reduced, causing strain on the ITB. Biomechanical studies have also shown that faster-paced running is less likely to aggravate ITBFS. This is because as the foot strikes the ground, the knee is flexed more than 30 degrees, avoiding the range where the strain occurs. Incorrect training practices can also contribute to the condition, such as starting a demanding routine of sport or exercise immediately following a return from injury, or otherwise expanding your training too rapidly.
A gradual increase to your training mileage (e.g. 2-3km per week) cannot be over emphasized. Your body won't get used to running long distances, unless it has run those distances on a regular basis. As the body needs rest between those runs, thus it is recommended that there should be no more than two long runs per week and moderate distance on the other days. Long training runs should be conducted at an aerobic capacity where you can talk and run at the same time. After a run, stretch and then ice the outside of the knee for 5-10 minutes. Last but not least, always train at an appropriate intensity. Training at higher intensities (>80% of Max. Heart rate) will lead to lactic acid production, which will fatigue the muscles and increase the chance of injury. To monitor the level of training intensity, a heart rate monitor may be a useful device.
Biomechanical Gait issues
Always wear appropriate shoes that give you proper support. A wet footprint test is a common method for determining your foot type. Get your feet wet and stand on a flat surface that will allow your footprint to be shown. Compare your footprint to the images below.
Now that you know your foot type, approach a knowledgeable salesperson at a running specialty store and they will be able to help you find the right shoes for you. A semi-rigid orthotic may also be useful for someone who have excessively flat feet or high arches, in bid to improve function by supporting the foot segments during gait. The orthotic is worn in the shoe and it helps by changing the position and time sequences talking place in the foot during running so that no one muscle or group of muscles have to work longer and harder than it should.