You may have more in common with Jean Claude Van Damme than you think. The “Muscles from Brussels” once joked, “I admit, I do have a very nice butt. Some say my career was built on it.” Indeed, the posterior also serves as the physiological foundation for all successful running careers. The largest and most powerful muscle in the body, the gluteus maximus fires every stride, sending signals to the surrounding muscles to propel you forward.
Considering the authority of the backside, it is not surprising that iliotibial band syndrome (ITBS) is the second most common injury for runners. Stemming from the fibers in the gluteus maximus, gluteus medius and tensor fascia latae muscles, the IT band wraps around the leg, becoming the thickest on the outside of the thigh as it travels down to the knee and attaches near the knee joint.
According to Dr. Jack Taunton at the University of British Columbia, ITBS has doubled in the last 10 years. Recent research shows that our pre-programmed approach to rehabilitation may be the reason we aren’t seeing greater improvements in symptoms among runners. With the stunning success of hip and core strengthening programs, the days of only stretching and rolling are no more. Even a full-blown case of ITBS can be eliminated in just four weeks with an exercise regimen that focuses on strength, rather than flexibility.
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Band Aid
“If there is pain on the side of your knee, it’s almost always IT band syndrome,” says Dr. Reed Ferber, director of the Running Injury Clinic in Calgary, Alberta. For many years we assumed that such pain was the result of tightness of the IT band. Like piano strings, we envisioned a band that was on the verge of snapping. As a result, treatment has focused on stretching and foam rolling, as well as prescription orthotics.
Ferber’s preliminary research, however, shows that only 12 percent of runners have a tight IT band. Interestingly, he also discovered that 80-90 percent had weak hip stabilizing muscles. This sent him back to the drawing board to identify better treatment options.
In a study published in February 2010 in the Journal of Orthopaedic and Sports Physical Therapy, Ferber and colleagues noticed several key discrepancies between runners with ITBS and those without. “Most of the differences between them were up at the hip,” says Ferber. “So the hip rotated too much and the hip collapsed inwards too much, and that drew the knee inwards.” In short, wonky hip mechanics were overworking the IT band, causing pain. Dennis Barker, head coach of Team USA Minnesota, has seen his fair share of ITBS among runners. He points to overtraining and doing too much too soon as the main culprits. As the runner ramps up his or her mileage, hip and core strengthening is oftentimes left by the wayside.
“Sometimes when runners start something, they go hog wild. It’s important to have a little patience in training,” says Barker. As the miles increase, so should the minutes devoted to strengthening those stabilizing muscles.
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Weakness in the glutes and hips isn’t always obvious. “The mechanics themselves are quite subtle,” Ferber says. “It’s nothing you could pick out with the naked eye.” Discomfort is one way to know if your IT band is being overworked as a result of weak muscles. “You’ll feel pain on the outside of your knee and it’s going to feel worse as your keep running,” says Ferber.
Aside from actually experiencing these symptoms of ITBS, a runner may also determine weakness by completing a single-leg jump test or single-leg squats. A study conducted at the University of Delaware found that the hip and knee collapsed inwards in a similar way when study participants ran, completed a single-leg jump, and performed single-leg squats.
The Backside of the Force
If the ITBS is already in full swing, Barker suggests backing off of running completely. “I don’t have them start until they haven’t felt it at all for three days,” he explains. Ferber also says that curbing mileage for a couple weeks can be helpful. Perform strengthening exercises instead of running your usual volume.
After following Ferber’s ITBS Rehabilitation Protocol at his Running Injury Clinic, 90 percent of runners experiencing ITBS were injury free after just four weeks. In addition to strengthening the gluteus maximus and the deep rotators, stretching and foam rolling, Ferber identifies the following as the most important exercises:
1. Hip Abductor Strengthening: Tie a theraband around an immovable object. Stand with your feet shoulder width apart next to the object. Wrap the band around the ankle of the leg furthest from that object, with the other leg behind the band. Move the leg with the theraband attached outward with the knee straight, like a side leg lift. Hold for two seconds and slowly bring leg down. Switch sides.
2. Hip Gluteus Medius Strengthening: With the band still tied, face the immovable object and pull your leg back to a 45-degree angle. Hold for two seconds, bring the leg down, and switch sides.
For injured runners, Ferber prescribes three sets of 10 reps, three times a week. He also suggests that healthy runners do these exercises once or twice a week.
While strengthening is the heavy hitter when it comes to combating ITBS, stretching still plays a role. The Team USA Minnesota runners, Barker says, “do a lot of dynamic drills, which are designed for hip flexibility.” The team includes Carioca, high skips, and walking lunges in their routines.
Ferber insists that although the foam roller is no longer considered the silver bullet, it is still useful for massage. “Your IT band is like a chunk of leather. You cannot make it much more flexible,” he says. “The foam roller is used to break up adhesion formation underneath the IT band.”
Ferber’s strengthening routine, with a side of stretching and rolling, has elicited great results for ITBS sufferers. Barker and Ferber agree, however, that prevention is always the best policy. “People say they don’t have the time for the prevention thing, but if you’re doing your training right, just 15 minutes is enough,” says Barker.
While it is yet to be confirmed, it is suspected that Van Damme also adheres to a strict core strengthening routine. His career is built on his backside after all, and so should yours.
