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Iliotibial Band Syndrome is actually a pretty common injury that occurs because of friction distally as the structure is stretched over the lateral femoral condyle the distal end of the long bone of the thigh. The reason this occurs is because there is a moment during the range of motion where the stretch is actually amplified by the greater trochanter of the hip which the ITB crosses over as well. When the structure is stretched over BOTH boney prominences the ITB is stretched maximally and is susceptible to failure, usually at the distal end, were it is not as wide. This actually occurs when the hip and knee are both slightly flexed, the position you are in all the time while running down hill, every step.
The ITB is made of collagen, the most prevalent protein in the animal kingdom. It is a true dense connective tissue.
Collagen is an organic crystal that actually fails gradually. Fibril by fibril. As the fibrils fail, the structure becomes weaker and eventually, enough fibrils fail that even the fibers are damaged causing pain structures to be stimulated and in turn, a local inflammation response occurs. When that occurs, you feel pain.
Treatment should be a combination of ice, NSAID’s, gentle stretching, rest and eventually, strengthening. Orthotics are a consideration because there might be a biomechanical component to your injury. I like The Stick as a tool as well. The key is to be patient. Because this is essentially a dense connective tissue injury, this injury really needs to heal before you tackle the next hill.
The time frame looks like this:
- 3 weeks from the date of the injury to return to about 20% strong,
- 42 days to about 40 % strong and
- 90 days to about 90% strong.
My advice is to take 6 to 12 weeks off before running hills again immediately after you get hurt, and focus on the treatment you need to return to normal activity as quickly as possible. Although, that said, you should be able to run up hills before you will comfortably manage the flats or downhill runs again. The bike can be a bit risky for the distal ITB, because repetitive pedaling could irritate the tissue as it crosses over the distal femur. Be cautious about riding too many miles too early. This goes for running too. Be alert to the way you are feeling as you build your mileage, and dial it back if the outside of the knees starts to hurt. Build your mileage gradually once you are feeling good, and be especially cautious during the down hill sections.
The good news is that once it is better, you should be able to run without fear again.
should the NSAID’s continue through the entire recovery? if not, at what point do you know they are no longer needed? i haven’t been taking any for over a week now and i’m hoping that hasn’t limited my recovery during that time. thanks, neil!
bryan
Comment by Bryan E. — December 5, 2008 @ 12:42 pm
Great question Bryan.
My advice is to try to get off NSAID’s and if the problem persists, then reload for another week or so, then try to reduce the NSAID’s again. This way, you can determine if there is still a chemical component of your pain present. The NSAID’s are prostoglandin inhibitors, so if you have pain that intensifies when you discontinue their use, my guess would be that there is still inflammation present. Prostoglandin is manufactured when cell membranes are broken down, and is a chemical that mediates inflammation.
One thing to consider with NSAID’s is that they are titration drugs which means that you have to have enough of them on board in order to make an impact on prostglandin formation. Not enough medication, and no anti-inflammation effect occurs. Different NSAID’s require different doses, and there are significant side effects to be aware of as well, so check with your doctor or local pharmacist in order to determine the therapeutic dose appropriate for your personal use.
Comment by Neil Chasan, PT, MMT — December 5, 2008 @ 1:21 pm