Below we outline a simple Iliotibial band friction syndrome rehabilitation program. The aims of rehabilitating runners knee or Iliotibial band syndrome are to reduce pain and inflammation, stretch the iliotibial band and TFL muscle, strengthen the surrounding muscles and identify any possible causes before gradually returning to full fitness.
Reducing pain and inflammation
This phase may last between two days and two weeks depending on how bad the injury is and how well it is treated. Rest from any activity that causes pain. Start with at least five days of complete rest from training.
When normal daily activities are pain free try doing other activities such as swimming or cycling. If these are not pain free then be patient and work the upper body instead. It is important to maintain a training routine of some sort.
Apply ice or cold therapy regularly. This will naturally aid in reducing inflammation. Initially ice can be applied for fifteen minutes every hour reducing frequency as pain allows. As a minimum cold therapy or ice should be applied at least three times a day.
Anti-inflammatory medication such as Ibuprofen may help in the first few days. Always check with a Doctor before taking medication. Ibuprofen should not be taken by asthmatics.
Stretching exercises for the iliotibial band should be done throughout the treatment process but is particularly important in the early stages. Because the ITB inserts along the length of the thigh bone it is argued stretching has a limited effect on the band itself and is probably more beneficial for the tensor fascialatae and gluteus maximus muscles.
Stretch very gently if there is pain or inflammation. Hold stretches for at least 10 seconds and repeat 5 times. Aim to repeat this routine at least three times a day.
Later in the rehabilitation process when initial pain has gone stretching can be increased. Hold stretches for up to 45 seconds and repeat 5 times. Repeat this routine three times a day. PNF stretching techniques can also be introduced when inflammation has gone. PNF stretches or proprioceptive neuromuscular fascilitation stretches involve contracting and relaxing various muscles and are best done with a partner or sports therapist to assist and provide resistance.
Sports massage techniques can be applied to the iliotibial band itself to help release tension and eliminate tight knots in the tendon. Massage to the tensor fascia lata muscle at the hip will also help release tension in the band.
Foam roller exercises are also commonly used to apply pressure along the length of the band and to release tension in the hip muscles.
Once initial pain has gone and a stretching routine has been established then you can begin to strengthen the structures involved. In particular exercises to strengthen the abductor and external rotator muscles (tensor fascia latae and gluteus medius muscle) should be performed.
Single leg squat maintaining a stable hip is one exercise. Begin with 1 set of 10 reps and gradually build up until you can complete 3 sets of 15.
See iliotibial band strengthening exercises for more detailed information.
Gradual return to fitness
This can often start within two weeks of initial treatment but will depend on the extent of the problem. Build up running time from a much lower point than you left off before the injury. A reduction to 50% of original mileage or time should be OK. Apply ice to the knee for 15 minutes after training.
Increase running time rather than distance for the first few runs. Running distance should be increased by no more than 10% a week (depending on original fitness levels). If you feel pain or the inflammation comes back then go back a couple of steps to reduce the inflammation and start again.
It is important to continue to stretch and do foam roller exercises. If the Iliotibial band (ITB) is tight then the injury is very likely to recur. Simply reducing the inflammation will not cure the injury permanently. Even when fully fit it is a good idea to get a regular sports massage which will eliminate tight spots and knots that can cause the ITB to tighten.
Identify possible causes
Check your training diary. Any significant increase in running mileage, change of surface, change of job or anything else out of the ordinary which could have helped cause the injury. Keeping a training diary allows you to look back and identify possible factors contributing to injury and avoid them in the future.
See a podiatrist or similar professional who can perform a full biomechanical analysis to identify any foot problems such as over pronation which may be causing the leg to rotate inwards twisting the knee.
Prevention iliotibial band syndrome
Here are our top tips to avoid ITB friction syndrome of the knee:
- Stretch regularly before and after running. Also stretch on the days you do not run.
- Get a regular sports massage, in particular to the Iliotibial band and TFL muscle. Most serious runners will have a regular sports massage which can keep muscles in good condition, aid recovery and identify any potential weak spots or future injuries before they occur.
- Increase weekly mileage or training time gradually. As a rule of thumb increase by no more than 10% per week. Listen to your body. You are not training when you are training, you are training when your body recovers and over compensates to the training load.
- Check feet for biomechanical disfunction (overpronation). If the feet roll in then this can cause the knee to rotate inwards, stretching and tightening the Iliotibial band. Ensure you have the correct shoes for your feet and running style.