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The Definitive ITBS Guide

kona_expat's picture
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started by kona_expat on February 15, 2007

I've been asked so many times to help people with this issue, which I've suffered from myself in the past. Keep in mind that no injury is isolated--you need to address the acute problem first, and then you need to keep hunting around for the root cause.

So herein is everything I've learned about ITBS and what you might be able to do about it:

IT band attaches to TFL (tensor fasciae latae) muscle, AKA ABductor, which helps your leg go away from your body to the side. The band itself is just fascia; so when people talk about stretching it, that's really a misnomer--what you need to do is stretch the TFL muscle. The fascia may have scar tissue on it though, which is why using a foam roller on the entire fascia can be helpful or just feel good. But my belief is that this provides relief because of an overly tight vastus lateralis, which lies right below the IT band. Tight vastus lateralis usually goes hand-in-hand with weak TFL.

ITBS can be due to a weak TFL, or overly strong ADductors (inner thigh muscles, which act to pull your legs toward midline--there are adductor magnus, longus and brevis) or imbalances between outer quad (vastus lateralis, which also sort of behaves like an ABductor) and inner quad (vastus medialis).

ITBS can also arise due to running on cambered (tilted) roads, which almost all roads are, or running on a track always in the same direction (either leg is susceptible to ITBS depending on whether the TFL is overstretched, weak or tight).

Lastly, underpronators (or supinators, meaning your foot rolls to the outside edge when running--this is common amongst people with high arches) are more prone to ITBS. Sometimes OTC or prescription orthotics plus the proper running shoe (usually cushioned with a bit of stability) are part of future prevention of ITBS, but if you already have it, you have probably incurred TFL issues!

Of course, you need to monitor the mileage on your running shoes, too, as at the onset of ITBS (or anything that hurts while running), the first thing to do is check your mileage.

Here is another description of ITBS.

Now that you have the complete technical descriptions, what you need to do is seek balance in the strength of your leg muscles and keep them limber. Since running and cycling are primarily unidirectional movements (legs only go forward and backwards in a circular motion), your ABductors may be underdeveloped or weak, which makes you susceptible to ITBS, and your quadriceps and/or ADductors may be too strong in relation to the TFL.

What you can do to strengthen the TFL is spend a few minutes walking sideways on a treadmill or a track once or twice a week, or if you have access to low pulley machine, do this.

If your TFL is overstretched, you need to do a couple of things: stop doing what causes the overstretching. If you run on cambered roads, you need to switch directions to put the affected leg on the HIGH side of the road for a few weeks (trust me, I've tried this and it works). Also, avoid stretching that leg's TFL for a few weeks. Once you resolve the ITBS, then you can begin strengthening and stretching the TFL. The very first hyperlink I provided shows one TFL stretch; here is another one, and here is the one that IMO, works the best.

If your vastus lateralis is tight, almost any quadriceps stretch will work, but you might also have trigger points in the muscle which will need to be resolved. I have found this book to be invaluable in maintaining my muscle health. It will teach you about what trigger points are and show you how to identify them and fix them. If you get regular sports massage, it helps if the therapist understands trigger points (the good ones do), and then you can ask them to work on ones you know you already have (for extra therapeutic benefit in addition to your own work) and also identify one you didn't know you had.

If you have a weak VMO (vastus medialis oblique), which many of us do, go here to read about that and see exercises that can help.

Bottom line is that running will uncover any muscular imbalances, tightness or weakness that you have. If you get a strength assessment and act on it, and then you stretch regularly, odds are that you won't suffer many injuries. But if you do fall victim to ITBS, know that it is usually quite resolvable, as long as you tackle all the potential causative factors.

kylie's picture
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kylie posted 1 year ago.

Yet again a wonderful post Kona -- It's great to have all this info and resources in one spot. Thanks!

Miles of Life --- Powered by MarkyV

sljv's picture
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sljv posted 1 year ago.

a few things in there that i havent come across, so thanks!!.. my problems is a quad imbalance, and weak abductors.. workin on that... would you recommend doing hamstring work to strengthen those? or is the imbalance mostly with quads/abductors

-josh

kona_expat's picture
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kona_expat posted 1 year ago.

Hamstrings usually will benefit from strengthening in runners and cyclists. I've previously posted my abs/core routine which has a bridging series that is great for hamstring strength.

But if your issue is abductor weakness, you will benefit most FIRST from strengthening it and your VMO. But if you have time to enhance your strength routine, yes, add hamstring work.

OzTriGuy's picture
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OzTriGuy posted 1 year ago.

Nice Post!!

Tikal Dog's picture
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Tikal Dog posted 1 year ago.

As always great post Kona. I think Tribro should have many of your posts on the main page of the site. You realy educate us all ;)

Hyperactive Trifueler!!!! (I refuse to let the status go :p)

kona_expat's picture
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kona_expat posted 1 year ago.

Thanks, TD. My only reticence in making this front page material is that I am not a licensed medical practitioner; I write from experience and self-teaching. But I'm told by some medical professionals that I am quite knowledgeable.

kevinb421's picture
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kevinb421 posted 1 year ago.

thanks for the information!

"If your not going to win, make the fellow in front of you break a record."

http://www.peak.com/kevinb421/blog/