The Mighty Grip of the IT Band

My Tryst with IT Band Syndrome (Running Injury)

“No matter how strong, how tough, how intelligent a person is, no one is invincible.”

The build-up and the passivity:

Invincible is what I thought I was. After all, I owned the tag of a seasoned runner having run a number of half and full marathons, and an ultra marathon (50 kms) to fortify the ‘seasoned’ label. I took immense pride in having a well-worked-out and resilient body, toughened with daily sessions of strength training and functional training.

The Mighty Grip of the IT Band

I mean, it wasn’t like I had just started running recently. Wasn’t this regime a good-enough warranty for an injury-free body that could bear the brunt of distance running? …. Revisit the above quote for the answer.

2011 to 2013 were the years when I took full advantage of my stellar running form. I signed up almost every half marathon I could lay my eyes on and ran like a maniac. It was either running at an event or busy with practise runs 4-5 times per week which comprised hill repeats, fartlek or interval training, tempo runs, a long weekend run and may be a laid-back cushy 3-5 km run if I had the fuel left for it. Running euphoria had possessed me to the extent that I didn’t even look forward to vacations, dreading that I would miss my running sessions with my buddies. Everything else could wait. Such was life for me at that point in time.

Bhatti Ultra Marathon (50k) was accomplished in good time; Airtel Delhi Half Marathon (ADHM) was just about 2 weeks away and Standard Chartered Mumbai Marathon (SCMM) was not too far either. Practise runs were at their culmination point for the imminent ADHM.

It was during one of these practise days that I suddenly felt a sharp pain on the outer side of my left knee joint. Although I slowed down considerably, I didn’t stop running. Once the run was over, I took no heed of the pain, passing it over as a one-off occurrence. But the pain was there to stay. Every time I tried to run, it shot back with heightened intensity. After around 6-7 kms into running, it would surface in a sharp and agonizing avatar. The longing to keep running kept me on my toes somehow. Within a week it was taper time, giving me the rest that the legs needed anyway. I finished ADHM with 2:01:01 with a constant dull pain in my left leg. Then started the long practise runs for the SCMM. The pain just got worse every time I crossed the 5k mark. It progressed on to my hip now.

While every sane runner would have visited an orthopaedic doctor or a physiotherapist at the very onset of pain, I smugly hobbled my way through my runs (if a limp here and a jog there could qualify as a run). In hindsight, that was the most foolhardy thing I could have done to my body!

The consequence

I stood there completely ready with my SCMM running number fixed neatly on my chest on the early morning of 19 Jan, 2014. The problem was that my body was far from ready. The defiance and doggedness to run this event at any cost had brought me thus far. But I finally developed cold feet on that momentous morning as I stood on my aching left leg mulling over the possibility of a DNF (Did Not Finish). The very thought of a DNF within an hour of running made me cringe. It was a DNS (Did Not Start).

I was now angry and frustrated with myself for ignoring my affliction for this long and decided finally to see a doctor. I was diagnosed with IT Band Syndrome.

What is ITBS and how it drives you up the wall

As defines it, Iliotibial Band Syndrome (ITBS) or IT band injury is one of the most common overuse injuries among runners. It occurs when the iliotibial band, the ligament that runs down the outside of the thigh from the hip to the shin, is tight or inflamed. Friction between the knee joint and the band due to a strenuous physical activity like running causes pain along the outer side of the knee joint. It may start with a needles-and-pins sensation and may even be accompanied by a clicking sensation due to the pull of the tight muscle, muscle spasms and swelling around the knee. It is a progressive injury where the pain can be debilitating until addressed in time. It usually results from overuse in long distance runners and bicyclists. Here are a few common causes pertinent to runners in specific:

  • Overtraining such as too much mileage without adequate rest and excessive uphill or downhill running;
  • Poor flexibility of joints and muscles;
  • Weak hip (abductor) and core muscles due to lack of strength training;
  • Mechanical imbalances/leg-length discrepancy caused due to training errors such as – always running on the same side of a sloped or cambered road which can tilt the pelvis.
  • Using old running shoes with heels worn out on one side.

How I had goofed up

The frustration of not being able to run SCMM and many other ensuing races led to a lot of soul-searching during this forced-pause period. I thought about where I went wrong despite the regular strength training and stretching sessions. I found myself guilty on the following counts:

  • Was squeezing in too much mileage into a week without taking adequate rest to allow my muscles to recover adequately. A classic case of too-much-too-soon;
  • Although regular with warm up routine, was skipping a proper cool-down on-and-off even after long runs;
  • Was sleep deprived with only about 3-4 hours per night leading to poor muscle recovery;
  • Was ignoring the strong signals of pain and continued to run audaciously;
  • Did not visit a doctor until the pain got the better of me. It was so distressing that it wasn’t funny;
  • Gave up on physiotherapy just after two sessions and neither did I follow a regular home-care regime, i.e. rest, foam-rolling, icing and deep tissue massage. All I sincerely did was - stretch.
  • Although strength training was a regular feature, had been ignoring this smaller muscle called abductor on the outer side of the leg. This is the muscle that lodges the IT Band.

The biggest bungle of them all

Missing SCMM in 2014 had left me very downcast, I guess. I gave in to a temptation of running a tough run too soon. So, instead of patiently working on my gradual recovery to return stronger, I literally added insult to injury by running a challenging 42km at Serco Trail-a-thon in Mar 2014. I hobbled on one leg through my entire run refusing to earn the tag of DNF. This was the most reckless running decision I had taken to date, which set me back by almost a year.

As an aftermath, I had to stop running almost completely for a year to allow full recovery. Foam roller was my bum-chum (well….literally!) and strength training was my crutch.

Lessons learnt the hard way, hence the gyan

Since IT Band Syndrome is a debilitating injury that can take much longer to heal if left unattended, don’t place too much trust in your self-healing powers! I sure learnt from my mistakes, and in case ITBS catches you by your leg, here’s what you should keep in mind:

Phase I (Rest and ice till your doctor examines you and plans for phase II)

  • Never ignore the pain around your knee or/and outer side of leg if it occurs on 2 runs continuously. Go see an orthopedist.
  • Rest as per the doctors instructions.
  • Ice the affected area twice a day.

Phase II (A few weeks till the initial irritation lasts)

  • Physiotherapy/deep-tissue massage/foam rolling
  • a. Physiotherapy: If physiotherapy sessions have been recommended, then finish all the sessions without giving up treatment midway.
  • b. Deep-tissue massage: If its deep-tissue massage that you have been suggested, get hold of a trained masseur especially to massage your outer leg and glutes muscles at least 2-3 times a week.
  • c. Foam rolling: In case getting a well-trained masseur is an issue, foam roller massage of the glutes and TFL muscles can help majorly. (Link to videos given below to guide you).
  • Stretch your gluteus maximus and TFL muscles 2-3 times a day. (Links to videos given below to guide you).

Phase III (After the initial sharp pain is gone)

  • Strengthen your hip and outer thigh muscles. It can be achieved through the following exercises: The Fredericson protocol, Clamshells, Side leg lifts, Hip hikes and Glute Bridge. You could even use a Thera-band for this strength work.
  • Cross-train to maintain general fitness.

In case you’ve been lucky not to be hit by ITBS, and you’re just reading this blog to be on guard and not be wise in retrospect like I was, keep in mind that you must:

  • Always start a run with 5 minutes of warm up comprising dynamic stretches or a slow jog.
  • Always end a run with a cool down comprising static stretches.
  • Change your shoes immediately on noticing that the heels are worn-out and sloping to one side.

The following quote makes a pitch for an apt conclusion:

“Recovery is a process. It takes time. It takes patience. It takes everything you’ve got.”

Some IT Band rehab exercises links I viewed during my recovery phase: