Patient Advice Leaflet
PhysioWorksNI
Ilio Tibial Band (ITB) Syndrome - Lateral
thigh pain
This is a very common injury that many
runners experience. While running, pain is felt
over the outside of the knee or less commonly
over the upper outer part of the thigh. It is
generally considered an overuse injury.
Risk factors
1. Tightness in the ITB band.
2. Poor control of the pelvis and lower
back.
3. Poor lower limb alignment - thigh rolls
in producing knock-knee position.
4. Over pronation of the feet – changing
trainers or a referral to a podiatrist
may be required.
5. Lack of a good stretching routine after
training.
6. Training errors - increasing mileage
too quickly, introducing hills or speed
work too quickly.
Treatment Protocol
With the right type of treatment and
management, this injury can be treated very
successfully with physiotherapy.
Phase 1 - Reducing pain, swelling and
inflammation
1. Rest from aggravating activity! Generally you will need to take a bit
of time off running – I know, every
runners nightmare – having to stop
training!! This can be from a few days
to a few weeks depending on pain
and inflammation and how long you
have had the injury. Generally if you
are running and the pain continues to
get worse as you run then it is better
to ‘bite the bullet’ and stop running
for a while. Other activities such as
swimming or core work can take the
place of running for a while and helps
keep the head sane!
2. Ice Ice Ice baby! – Applying ice as
soon as possible is so underestimated! Ice cools the tissues and
helps to settle the inflammation and
ease pain. Make sure you use oil on
the skin or a damp towel between the
ice pack and the skin to prevent an ice
burn. 10 minutes at a time is
sufficient.
3. Physiotherapy
A good sports physiotherapist will
assess your injury and will work out a
specific treatment programme for
you. They will assess which risk
factor/s has contributed to your
injury. You may have poor core
control or it may be lack of
flexibility/tightness. Whatever is
highlighted it is essential that it is part
of your treatment programme so that
you are not plagued with this injury
every season!
4. A sports physiotherapist will also carry
out effective massage therapy - deep
soft tissue massage e.g. myofascial
release is great for easing out and
loosening the ITB band. This can be
extremely painful but is so effective.
Massage treatment is not only to the
ITB band but is generally needed to
loosen associated muscles around the
hip and lower back. Other forms of
treatment that can be very helpful are
kinesio taping, ultra sound and
acupuncture.
Physiotherapy for Everyone!
Patient Advice Leaflet
PhysioWorksNI
Bent knee fall out
Phase 2 - Rehabilitation
Acute inflammation and pain is settling well.
1. Stretching
I have found over the years the best way to
stretch the ITB is with a foam roller. Every
home should have one!
Keep pelvis steady and roll 1 knee
out to the side and back in x 10 reps.
Alternate left and right knee.
Knee fold
Roll up and down along the outer
thigh. Initially the roller will bring
tears to your eyes but it will get easier
with regular use!
Keep pelvis steady. Draw left knee
over hip and then set foot back to
floor. Alternate left and right knee
x 10 reps.
Other stretches
Spine Curl 1
Hamstring and calf stretch with band.
Peel spine from floor then paste back
down bone by bone x 10 reps.
Spine Curl 2
Hip and front thigh stretch. Keep
lower back into mat.
2. Strengthening/Core control
Rule of thumb is if it doesn’t hurt to do the
exercise you’re ready to start. If pain is made
worse with the exercise, stop and leave it for
a few more days and continue with phase 1
protocol.
Once up in bridge position lift one foot
up. Alternate left and right x 10 reps.
Keep pelvis still.
Physiotherapy for Everyone!
Patient Advice Leaflet
PhysioWorksNI
Oyster
Open knee to ceiling. Keep hips still
x 10 reps.
Knee forward and back
All standing exercises can be done on a
wobble board for that extra challenge!
3. Cycling or swimming can be
introduced if pain free.
Phase - 3 Phased return to running
Keep pelvis steady x 10 reps.
Standing balance
Start when able to walk and go up and down
stairs without pain. Great if you start on grass
and on a flat surface – no hills yet! Should be
pain free. Introduce hills and increase speed
gradually. Never introduce hills and speed in
the same session. Initially never run 2 days in
a row.
Prevention
After treatment from a good sports
physiotherapist you will know what factors
you need to work on. Below is a good overall
programme to continue with to keep you
injury free.
Keep pelvis level and make sure you
keep knee over foot - no knock knees!
When steady, progress to single leg
squats x 10 each leg. This can be
done on a block. Great exercise!
1. Get used to a consistent
stretching routine after training or
racing. You will notice the
difference in a couple of weeks as
to how the body feels, especially
after your harder training sessions
and races.
2. A regular massage by a good
sports physiotherapist. As a
runner myself I have learned the
benefits of this! Generally is
painful but the more regular the
massage the easier it gets!
Physiotherapy for Everyone!
Patient Advice Leaflet
PhysioWorksNI
3. Continue use of roller for legs and
back.
4. Continue with strength work for
the legs and back as above. I
would also advise runners to add
in general lower leg conditioning
exercises e.g. weights or circuit
classes as part of their running
regime. Most runners lack
strength in the major leg muscles.
This can be great for prevention
of many running injuries.
5. Continue with balance and core
work.
Physiotherapy for Everyone!