For many who ultimately join the ITBS Club, the injury has similarities to a bad neighbor. Your initial hopes are that it is not really there. However, as the pain worsens and reality sets in, you slowly begin to go through personality changes, weight loss, and even marital problems due to the tremendous aggravation and stress it produces.

For those unfamiliar with this very common syndrome, pain on the outside of the knee that worsens with time should be considered as ilio-tibial band syndrome until proven otherwise. It can become a debilitating condition and, unless the underlying cause is addressed, it generally will return.

Causes

The primary cause of this condition is repetitive motion with the involved muscle without ever allowing full recovery. Our body's defense system produces an inflamed situation, which we feel as pain, tightness, and swelling. It is hoped that we will obey the laws of life and stop the offending exercise and work to correct the condition. Underlying and influencing factors that contribute to the onset and duration include leg length difference, worn shoes, uneven running surfaces, increased mileage, and lack of proper warm up and cool down. All of the thigh muscles, including the quadraceps and hamstring, are victims of this repetitive motion in runners and are vulnerable to the same fate. Repetitive motion disorders are also commonly found in industry today and manifest as carpal tunnel syndrome and low back pain. These are but two of the more common work related injuries causing severe financial burdens and frustrations to many employers and employees. All too often, treatment deals only with the symptoms, and this condition requires additional causal treatment to alleviate it.

Primary muscles used in any activity repetitively require specific attention. If not, they will slowly tighten due to an accumulation of unwanted toxins and a reduction of normal blood flow (nutrition and oxygen) to the muscle. The situation producing symptoms experienced in and about the knee are similar to the tightening of a violin wire. The muscles of the front and lateral (outside) thigh begin to tighten due to increased exercise and a diminishing supply of blood flow. Tightening begins to affect the ilio-tibial band and symptoms begin.

Correction

Much like any other structural condition, corrections should be made based on logic, simplicity, and cost. Surgery would never be the first recommendation to any runner, whatever the degree of symptoms. The first step would be to incorporate some form of anti-inflammatory treatment. This would accompany a "no running and no stretching" period to increase the likelihood of breaking the pain cycle without producing further damage. Icing for 20-30 minutes at a time (5-8 times per day) is essential. Some type of ace bandage or elastic support would also benefit the injury. An anti-inflammatory, such as Motrin or naprosyn, is a good complement. All natural anti-inflammatories are preferred, such as bromelain, but any agent is better than none in breaking that pain cycle.

Now that the inflammation is being addressed, the underlying cause must be addressed. The repetitiveness of the muscle use produces a congested, tight, and contracted muscle/tendons situation. Multiple massages on a daily basis to the muscles above the symptomatic sight is critical. It is mandatory to increase the blood volume coming to the muscle belly, while reducing the internal muscular pressure above the tendon to improve circulation, thus lengthening the muscle through relaxation of the fibers. This lengthening will take much of the stress off the tendon and allow the healing process to begin to work.

There are a couple methods for massaging the involved area. One is to have a friend work the lower half of the outside of the thigh with their thumbs for 20-30 seconds at a time. This can be repeated 4-5 times per day to encourage blood volume to the muscle. The massage should start about halfway up the outer thigh and come down just above the knee joint. When tender and sore areas are found, localized agitation should be done. This can be extremely tender and painful, but pressure should be to the tolerance of the injured and no greater. Despite the fact the ITB is over the knee joint, that area does not need to be massaged. The muscle above the knee joint is the key. A second method is to apply the thumb pressure to yourself or consider a tool such as The Stick(R).

Now that all proper healing methods are in place, a bio mechanical exam should be done to find contributing factors. This should work to minimize recurrence. That leaves the big question, "When can I begin running again?" The answer is simple -- when you can run without pain. Still, under no circumstances should you fly without a net once healed. Continue the therapeutic portion of this article until you are totally convinced you can go it alone. Don't be too discouraged if that day never comes.

For information on specific injuries, Dr. Maggs can be contacted at (800) 987-7845 or Running Doctor.