Introduction to Running Injuries
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.
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.
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 under-estimated! 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.
Phase 2 - Rehabilitation
Acute inflammation and pain is settling well.
I have found over the years the best way to stretch the ITB is with a foam roller. Every home should have one!
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!
Hamstring and calf stretch with band.
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.
Bent knee fall out
Keep pelvis steady and roll 1 knee out to the side and back in x 10 reps. Alternate left and right knee.
Keep pelvis steady. Draw left knee over hip and then set foot back to floor. Alternate left and right knee x 10 reps.
Spine Curl 1
Peel spine from floor then paste back down bone by bone x 10 reps.
Spine Curl 2
Once up in bridge position lift one foot up. Alternate left and right x 10 reps. Keep pelvis still.
Open knee to ceiling. Keep hips still x 10 reps.
Knee forward and back
Keep pelvis steady x 10 reps.
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!
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
>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.
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.
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!
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.