Iliotibial Band Syndrome FAQs
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Iliotibial band syndrome is a frustrating injury as it can be aggravated each time the knee is bent and straightened through 20-30º. That angle is passed through when we walk, run, cycle, row, use the cross trainer, get up from sitting, you get the picture. The sports most likely to see IT band syndrome are running, cycling, and long-distance walking. To a lesser extent, rowing and golf are also fairly common. Learn more about this injury here: Iliotibial Band Syndrome and here for: How do you fix Iliotibial Band Syndrome?
Running with severe or acute IT band pain is not recommended and will delay your recovery. There is a school of thought that the best option is not to run if there is any pain. As the injury is an inflammatory condition, therefore when pain is felt, inflammation is being provoked and therefore the condition is being worsened.
Many people who have long standing or chronic IT band pain will manage it, and therefore run within a their tolerated range of pain. With some chronic cases the band can become thickened and the local nerves sensitised, meaning a complete resolution of pain is less likely.
Strength and conditioning is a great way to increase your tolerance of running with IT band pain, read more here: IT Band Exercises.
Iliotibial band pain can be linked with excessive lateral movement at the knee, landing on the heel with a straight knee, and having a narrow gait. Some of these running styles can be tolerated better in highly cushioned traditional running shoes. Therefore, an argument can be made that running with less cushioning will encourage better running technique. Especially a change for a heel strike to a mid or forefoot strike which may also change elements such as the knee angle when landing. Which in turn might reduce the compression on the IT band.
However, barefoot running is a complex topic. If anyone shifts from running in traditional trainers to barefoot shoes without sufficient time for adaptation (which could mean years of gradual changes) it will not be successful and will likely result in a range of injuries.
Running assessments and advice are best done on an individual basis. A physical therapist or running specialist coach will be best to see how you run and what changes would make the best difference to your symptoms when running.
If you have acute or severe IT band syndrome pain, cycling may irritate theses symptoms.
Cycling takes the knee through the 20-30º knee angle, that can irritate iliotibial band syndrome pain, with each revolution of the pedal. Additionally some cyclists have an inward movement of their knees towards the top tube of the bike. This movement is called adduction and can also aggravate IT band pain. A good bike fit will look at your movement on the bike and provide you with the best position, as well as advice on exercises and drills that will get you out of bad habits, such as the inward knee movement.
If your pain is very mild and caused by something other than cycling, then you might find that cycling is ok to do, and has little or no irritation of your symptoms.
Saddle height can have a huge impact on your overall position on the bike, as well as on the angle of your knee, and the forces through different joints. An angle of 27-37º is a good range for the straightest position of your knee. However, the ideal saddle height varies from person to person, with different elements affecting the choice, such as hamstring flexibility. A general rule is that you should just be able to turn the pedal with your heels on the pedals, without tipping your pelvis side to side. This would mean that once the ball of your foot is on the pedal, especially if you have cleats, that your knee will be bent to an appropriate angle. You can find out more about bike fitting here.
Rowing takes the knee repeatedly through the range of maximal compression of the IT band on the lateral femoral condyle and therefore there is a risk of developing pain. Typically this injury will develop if there is additional stress and compression to the IT band. Such as if the knee moves inwards, when rowing, or if running is done as a complementary sport and there is poor technique. Or if strength and conditioning is not adequate to the demand of the sport. Or lastly if training volume or intensity is suddenly increased without adequate time to adapt and recover.
The leading hip though a golf swing will stay fixed on the ground while the body rotates over it. This twist can stretch and compress the iliotibial band over the lateral femoral condyle and cause the overuse injury of IT band syndrome. Good strength and conditioning will reduce the chance of developing this injury, as will having a gradual increase of training and adequate recovery from high volume or intensity periods of play. Building strength through the gluteal and abdominal muscle will ensure a better control of the is movement, and flexibility work of the thoracic spine and hip muscles will reduce the stress on the IT band.
This is not medical advice. We recommend a consultation with a medical professional such as James McCormack. He offers Online Physiotherapy Appointments for £45.