Runners: Do You Have Chronic Recurring Iliotibial Tract/Band Pain, Even With All The Rolling?

Every sport or athletic activity has their own set of common aliments and injuries. In football it's torn ligaments and concussions, tennis is the wrist and elbow, yoga is the neck, cross-fit it's usually the shoulders, and in running it's the knee and iliotibial band pain.

All are great sports and I recommend ALL of the above to my patients and you need to know that these aliments are common and for the most part PREVENTABLE.

Most reading this are runners, so I will be brief with the anatomy lesson. The iliotibial tract or band as it's commonly referred too is connective tissue and runs from the Ilium (pelvis bone) to the lateral superior aspect of the tibia (the outside part of the lower knee).

Because the iliotibial tract is connective tissue for example, like tendons and ligaments blood supply IS NOT as plentiful as say a muscle would normally be supplied. This means that connective tissue heals S-L-O-W-L-Y.

Connective tissue does what it's name implies - CONNECTS bone to bone for stabilization of joints - and connective tissue is found all over your body, from your head, spine and even your little toe.

For example:

A runner complains of outside of thigh and knee pain. Some common solutions are:

Correct running shoes ( I recommend FleetFeet) with orthotics
Proper training technique
NSAIDS
ICE
Elevation
REST
Massage and stretching (which runners LOVE to stretch, Right?)
Rollers all types
Physical Therapy with eclectic stim, ultrasound, work hardening, stretching, etc.

All of the above is designed to increase how well you function and works well. What I am talking about is when you have done all of the above have seen improvement and still have pain.

This pain is not normal, not supposed to be common and does alter your running style or bio mechanics - which leads to chronic pain.

What else is there?

Structure dictates function. Just like a dump truck is designed to well, dump - a Ferrari is designed to go really fast.

Your pelvis, and foot are designed to handle the load or pressure of running, jogging and walking - if there is pain something is WRONG.

A abnormal structural shift of your pelvis will create abnormal loads to your iliotibial tract, which will also inflame your iliotibial bursa (pillow that lays under the tract and slow to heal as well). This will cause tight or shorten muscles in your pelvis area, for example your Psoas, Piriformis and the forgotten Satorius muscle.

And of course the weakness of the quad or thigh muscles. Muscle as everyone knows moves your bones. Bones are levers (HS physics class), if the levers are not at optimum MORE WORK (energy) must be done by the muscles.

That scenario leads to injury and chronic pain.

For example if you have over pronated or supinated feet, an anatomical short leg or a malformed pelvis and like to run for exercise, the excess load not properly handled will create pain. No matter how much stretching or icing you do - if the structure is not addressed you will have chronic problems.


What to look for?

Some good objective indicators are:

1.) One hip lower than the other - put your hands on your hips and look in the mirror, is their a noticeable difference?
2.) Chronic pain or easily aggravated - even when you are doing everything else correctly.
3.)Degeneration in your SI joints or hip joints or knee joint
4.)Degeneration in your connective tissue - like your knee Mencius.

What to do?

Usually most runners have the proper foot wear (that is huge) and they stretch (well some do). They also have running form down - very important.

What I recommend is have your structure of your pelvis evaluated. A proper evaluation is with the use of Standing or weight bearing Structural Corrective radiographs. This is how we visualize anatomical short femur heads (legs) or a malformation of your sacrum (a bone in your pelvis -that is your foundation for your spine and key stone of your pelvis). This is standard in our office we do with every patient.

The correction is to enhance any structural abnormality closer to the normal range.  When your structure is OPTIMIZED your function (running) is enhanced, ending the chronic cycle of SI joint pain, iliotibial band pain and the common runners knee.

Soft tissue rehab is important and what is often overlooked is Structural Correction (which very few know to even do - which is why if results matter than so does the technique), which usually makes all the difference.