How To Treat ITB Syndrome

Treating ITB Syndrome, A Physiotherapists Perspective

As a Sydney physio practicing in an exercise crazy city and a runners paradise, like many other physios I am frequently called on to assess and treat knee pain, including ITB complaints. Treating ITB syndrome requires the physiotherapist to look at all of the potential causes and assessing the likely involvement of each potential factor any athletes unique situation. Frustratingly for the athlete however, is that as a rule with ITB complaints if you don’t look to give yourself a break and reduce your training load in some capacity, then you can expect your pain to persist and risk the ITB syndrome (ITBS) becoming chronic. It is a good idea to cease running, or cycling (or both, depending on what brings on the symptoms) as soon as you notice any ITB pain and go and get assessed by a physiotherapist.

Assessing And Addressing Foot Biomechanics

“Excessive” rolling-in of the foot during running (referred to as over-pronation) is a contentious topic, but a theory behind “over-pronation” having a role in ITB complaints is that this movement in the foot can cause your shin bone to rotate inwards during stance phase when running ultimately placing extra stretch and strain on the ITB. Assessing the biomechanics of the foot and footwear by a physio, or podiatrist may reveal the potential relevance in the short, or long term for shoe inserts (orthotics). Footwear, or orthotic prescription regularly can play an important role in ITB Syndrome management.

Assessing For Hip Muscle Weakness

Muscular weakness in and around the pelvis can be another potential cause, or contributor of ITB syndrome. Specifically, a weak gluteus medius muscle in long distance runners is seen as a common cause of ITB syndrome. Assessing for any isolated and importantly any functional weakness in muscles of the hip and pelvis can help your physio create a program of strengthening exercises. Exercises targeting both the strength and timing of gluteus medius and other hip stabiliser muscles. Improving postural control around the pelvis and reducing any Trendelelburg gait (pelvic tilting) through correcting any relevant muscular weakness can help prevent the onset of, as well as treat existing ITB complaints.

Addressing ITB Tightness

Despite sometimes being referred to as “the runners muscle” your ITB is not actually a muscle The ITB is in fact a very thick piece of fascia, passing from the hip down to the knee on the outside of each thigh. As a result, you can’t actually stretch the ITB, as fascia doesn’t respond to stretching in the same was as your muscles do. However, having said this your physio may still prescribe you some stretching exercises with the goal of lengthening muscles in your hips that “feed” into the ITB, as well as any muscles in proximity to the ITB,  all with the intention of helping to make soft tissues in the area more mobile and ultimately move and glide easier when active.
Combining and prescribed stretching activities with the use of a foam roller, or therapist directed massage techniques to the thigh and hip musculature with the goal of releasing ITB and associated tissue tightness can be an effective treatment for ITB syndrome.

Prevention of ITB Syndrome

As the saying goes, a pinch of prevention is worth a pound of cure. ITBS can be a persistent and frustrating condition for the athlete and challenging to get rid of when it strikes. Therefore the ideal is, that you don’t get the syndrome in the first instance. Some of the steps you can take in the prevention of ITB syndrome can include:

• Get fitted professionally for your running shoes – either at a specialist running store, by a physiotherapist with a special interest in running, or ideally a sports podiatrist. Skimping on your running shoes is false economy, as the dollars you save ultimately you may well end up spending, even spending ten fold more on treatment for a condition the right shoes in the first place could well have helped prevent.
• Shoes age – just like you, shoes age so make sure you change your shoes regularly, as much as they may be your favorite, the same pair of shoes won’t last you years.
• Try to avoid running on cambered surfaces – running round and round a track in the same direction can be an easy way to create a overload to one side of the body, if you have to run around a track mix up your speed and direction in an attempt to avoiding repetitively loading the tissues.
• Avoid Tarmac – ideally running on a more forgiving surface than tarmac such as running around a football field, park, trail or soft sand can reduce forces on the knees but also the variation that these surfaces can again avoid repetitive overloading the knee and your ITB.
• Consider cross training – mixing up your training will mean you aren’t always repeating the same activity day after day and performing the exact same motion at the knee every day. This could be as simple as changing your running surface or running speed, or as varied as bring in a weights session, some swimming, or yoga…

Most importantly, don’t ignore the problem. As a rule I find my patients will very seldom be able to simply run through the pain ITBS, some treatment and activity modification is almost always necessary. So the sooner you consult your physiotherapist, more likely the sooner you will be back training pain free.

Disclaimer: Sydney Physio Clinic does not endorse any treatments, procedures, products mentioned. This information is provided as an educational service and is not intended to serve as medical advice. Anyone seeking specific advice or assistance regarding How To Treat ITB Syndrome should consult his or her orthopaedic surgeon, general practitioner, sports medicine specialist or physiotherapist.