IT Band Issue - Causes and Solutions
This is the best article I have seen that covers the anatomy of the IT band, what the typical issues that cause it to become a problem and most importantly how to fix it.
Injury Series: Biomechanical solutions for iliotibial band (IT band) syndrome / ITBS
The fix is to strengthen the hip abductor strengthening program. Below is the stretches and exercises suggested in the article. Minus the pics.
Take the time to read the full article.
Matt
Biomechanical solutions for a biomechanical problem |
Fredericson et al. 2000. Healthy runners avg. 9.7-10.2 |
This brings us back to Michael Fredericson's 2000 Stanford University study. Unlike many retrospective examinations of injuries, his study took the additional step of prescribing a six-week strengthening and stretching program. While the usefulness of stretching is questionable (see below), a strength program for rehabilitating the hip abductor muscles is, scientifically speaking, the most sound long-term solution to IT band syndrome. Unfortunately, there hasn't yet been a randomized, controlled trial of runners with ITBS—Fredericson's study didn't even have a control group! But his results were indeed impressive: following the six-week protocol consisting of two stretches and two strength exercises, 22 of the 24 athletes (92%) in the study returned to running. Additionally, their hip strength improved markedly: their strength values after rehabilitation were comparable with healthy runners who did not have ITBS (see figure to right). Is this the randomized clinical trial we need to "prove" the efficacy of hip abductor strengthening exercises? No. But, combining this with the reams of indirect evidence indicating hip abductor weakness as a major factor in the development of ITBS, am I comfortable recommending hip strength exercises as the prime choice for rehabilitation and prevention? Yes.
The following is the program that Fredericson et al. prescribed to their subjects in 2000. It's by no means perfect, and I have some suggested additions which I'll present separately, but currently it's the closest we have to an "approved" hip abductor strength program that's been evaluated in the scientific literature:
The Fredericson Protocol for ITBS:
The exercises prescribed by Fredericson et al. are illustrated below. The stretches, denoted (1) and (2), were performed three times per day, 15 seconds each on both sides. The strength exercises, denoted (3) and (4), started at one set of 15 repeats once per day and built by 5 repeats per day, assuming there was no soreness from the previous day, up to three sets of 30 repeats once per day. The program lasts six weeks. Additionally, nonsteroidal anti-inflammatories (presumably Advil, Aleve, or similar) were prescribed for the first week or so, until pain with daily activities disappeared.
The following is the program that Fredericson et al. prescribed to their subjects in 2000. It's by no means perfect, and I have some suggested additions which I'll present separately, but currently it's the closest we have to an "approved" hip abductor strength program that's been evaluated in the scientific literature:
The Fredericson Protocol for ITBS:
The exercises prescribed by Fredericson et al. are illustrated below. The stretches, denoted (1) and (2), were performed three times per day, 15 seconds each on both sides. The strength exercises, denoted (3) and (4), started at one set of 15 repeats once per day and built by 5 repeats per day, assuming there was no soreness from the previous day, up to three sets of 30 repeats once per day. The program lasts six weeks. Additionally, nonsteroidal anti-inflammatories (presumably Advil, Aleve, or similar) were prescribed for the first week or so, until pain with daily activities disappeared.
The athletes were instructed to avoid running for the six-week rehab program, though they could cross-train if it did not cause pain. As mentioned earlier, 92% of the athletes in the study recovered after this rehab period (though the lack of a control group makes it impossible to say why they got better: the 6 weeks' rest, the hip strength, the stretching, or the anti inflammatories!).
Recommended additions to the Fredericson protocol
I recommend doing three additional exercises for hip strength. Two of these I got from Dr. Rob Johnson, an orthopedist and practitioner in the Twin Cities (who incidentally authored one of the first major studies connecting hip muscle weakness to running injuries), and the third I got from a physical therapist in the Twin Cities area. I think these three are important additions because the Fredericson protocol lacks any external rotation component (hence the "clamshells") and also lacks any isometric exercises (hence the glute bridge and wall press). While the wall press doesn't carry the "stamp of approval" of any published researchers I know of, I doubt it'll be highly controversial—if you don't trust me, then axe these ones and just do the above protocol. For lack of anything better, you can start with 1x15 and build to 3x30 with these strength exercises as well.
Recommended additions to the Fredericson protocol
I recommend doing three additional exercises for hip strength. Two of these I got from Dr. Rob Johnson, an orthopedist and practitioner in the Twin Cities (who incidentally authored one of the first major studies connecting hip muscle weakness to running injuries), and the third I got from a physical therapist in the Twin Cities area. I think these three are important additions because the Fredericson protocol lacks any external rotation component (hence the "clamshells") and also lacks any isometric exercises (hence the glute bridge and wall press). While the wall press doesn't carry the "stamp of approval" of any published researchers I know of, I doubt it'll be highly controversial—if you don't trust me, then axe these ones and just do the above protocol. For lack of anything better, you can start with 1x15 and build to 3x30 with these strength exercises as well.
*Clamshell leg lifts
Very similar to side leg lifts (exercise 3 in the Fredericson protocol), but the knees are bent, meaning your legs "open" like a clam, externally rotating instead of simply abducting. As with the side leg lifts, go slowly and ensure the hips are straight above each other, not tilted forward or backwards.
Very similar to side leg lifts (exercise 3 in the Fredericson protocol), but the knees are bent, meaning your legs "open" like a clam, externally rotating instead of simply abducting. As with the side leg lifts, go slowly and ensure the hips are straight above each other, not tilted forward or backwards.
*Pelvic tilt into glute bridge, 5sec hold at top
This exercise is done lying on your back with your knees bent. "Tilt" your pelvis up by drawing your stomach in, then, keeping your pelvis "up," use your glute muscles to go into what's called a "glute bridge" and hold it for 5sec, then lower back down and "untilt" your pelvis.
This exercise is done lying on your back with your knees bent. "Tilt" your pelvis up by drawing your stomach in, then, keeping your pelvis "up," use your glute muscles to go into what's called a "glute bridge" and hold it for 5sec, then lower back down and "untilt" your pelvis.
*Isometric wall press 15x5sec
Stand perpendicular to a wall, with your shoulder, hips, and foot against it. Raise your inside leg up so your thigh is parallel to the ground and your knee is bent at 90 degrees (like you were stepping up onto a bench). Then use that raised inside leg to push against the wall. You should feel it in your glutes on the OUTSIDE leg as it resists (isometrically) the pressure from your inside leg/the wall.
Stand perpendicular to a wall, with your shoulder, hips, and foot against it. Raise your inside leg up so your thigh is parallel to the ground and your knee is bent at 90 degrees (like you were stepping up onto a bench). Then use that raised inside leg to push against the wall. You should feel it in your glutes on the OUTSIDE leg as it resists (isometrically) the pressure from your inside leg/the wall.
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Comments
another great find Matt! will share w/ my wife!
Obviously I also did some ART and Physio, but the combination of all of these things has me running again. If you want the deets of what I did in the water I can provide you with that.
Paula
FWIW, I had some major IT band pain a couple of months ago with no combination of rest or stretch or cheesy neoprene strap
helping recovery. In desperation and longing for my midday workout I got on a stationary bike and just pedaled freely no real work no real focus on cadence or effort just let my legs do their thing fo 30-50 minutes. That just broke everything free and I was back up and training in days feeling much better by the next day. I now added 5 mins of similar light spinning after every run of moderate or higher intensity and have had no problems since.
Not sure if there is any science to my experience but figured I wold share nonetheless.
- Jose
This should go in the wiki under how to fix IT band...
Many times IT band issues can be traced back to weak gluteus medius muscles. The gluteus medius lies under the gluteus maximus muscle, and plays a part in pelvic stability when standing on one leg. In other words - it helps keep the pelvis level, and keep it from dropping on the opposite side during running. All the exercises in the article above are aimed at strengthening the gluteus medius specifically, or the entire group of muscles that provide that stability. I also found that the standing head to knee pose in Bikram Yoga targets that muscle extremely well - the large amounts of torque required to keep the opposite hip level in that pose really hits the gluteus medius.
When I was recovering from IT band issues, I also found this article from Chi Running (http://www.chirunning.com/blog/entry/it-band-syndrome). It is one of the most well articulated descriptions of what happens in the body, and specifically the pelvis, that results in IT band issues.
For what it's worth, a contributing factor in my case was quad/hamstring tightness, in areas where those muscles attach to the IT band. So for me, a deep tissue massage went a long way to providing acute relief - but it didn't fix the core problem. Ultimately, improved form and a stronger gluteus medius did.