Overview: In lay terms, the IT (illiotibial) Band runs from the lateral hip and attaches down below the outside of the knee. IT Band pain is one of the most common of running injuries, usually manifested in the form of pain on the side of the knee although it is sometimes felt up in to the hip area as well.

Potential Causes: In many cases, it is thought that IT Band pain is caused by a muscle imbalance caused from running downhill fast or from running on flat, even, man made surfaces in combination with over-striding/heel striking. Typically, the runner with IT Band pain has central Quadricep muscles that are too strong in relation to the Gluteus Medius and Minimus (stabilizing muscles of the butt). Since the Glutes are unable to hold tension, the IT Band is pulled tighter across the side of the knee, causing the commonly felt outside of knee pain.

The most common scenarios we see are:
1) Runners coming in the shop complaining of IT Band pain a few days after a downhill race or a long run on a flat, even surface (like a road or treadmill). Usually this type of run puts more work on the quads, which causes the imbalance to get worse and the IT Band pain to manifest.  (Many times this scenario is in combination with #2, below)
2) Over-striding or heel striking runners, especially those who run fast or do speed work.

Treatments:  Like with many injuries of this nature, the key to success is getting to the root of the problem by 1) Letting the affected area relax & calm down, 2)  Stretching to loosen up the tension, and 3) Strengthening to correct the imbalances.  Below are some specific ways to do that for IT Band.

1) Short Rest – Just enough for the area to calm down—a few days to just beyond a week is usually enough.  IT Band problems don’t necessarily get better with rest beyond a couple of weeks. Many runners report taking six months or even a year off and coming back to the same problem as soon as they start back in to a training program. This is likely due to the fact that in most cases, a muscle imbalance stays a muscle imbalance. The other piece of this is that a runner doesn’t usually change their running technique drastically after a break either.

2) Break Up Scar Tissue:  While the pain is felt down by the knee, the root of the problem is up in the hip area.  The use of Massage, a foam roller, ASTYM, or other similar treatments will help to reduce the scar tissue that can keep injury recurring.

3) Stretching & Strengthening: We see great success here at the shop with those who do ‘Side-leg lifts’, ‘Standing side leg lifts (Fire Hydrants)’, and one legged squats in order to combat the muscle imbalance.  Pair the strengthening with IT Band stretching exercises and using a foam roller.  See this great article for details on stretching exercises and foam roller usage for IT Band: Stretches & Strengthening: http://runningtimes.com/Article.aspx?ArticleID=6099&CategoryID=&PageNum=1

Foam Roller or massage deep twice a week

3a) GO UNEVEN!—Get off the road (or treadmill!) & walk the downhill: Many runners suffering with IT Band pain report that they can run much farther on an uneven surface (like grass or a dirt trail) before the pain manifests.   The more uneven the surface is that you run on, the more you can strengthen the gluteal muscles and reverse the muscle imbalance—this is key to solving the root of the problem.  In addition, walking any relatively steep downhill portions of the run will keep the quadricep muscles from being worked as hard and allow the runner to go longer without pain.

3b) Avoid Overstriding: Many runners overstride or strike their heel well out in front of their body which causes a pulling motion that puts a lot of extra stress on the IT Band.  Taking a running technique class can be very effective in helping you understand what is going on with your foot strike and how to fix it.  Most, if not all great Running Specialty Stores offer some kind of running technique class for minimal cost.  Here at our shop, we have found Zero Drop shoes (shoes with the heel and the forefoot the same distance off the ground) to be highly effective for many people suffering from IT Band pain.  In some cases, we have seen collegiate runners shake their IT Band in as little as a week simply by switching to Zero Drop shoes.  The theory here is that traditional running shoes, which have a midsole that is twice as high (& twice as heavy) in the heel as in the forefoot, actually encourage (or almost force) overstriding and heel striking because the weight of the back of the shoe pulls the heel toward the ground and the excess material under the heel catches the ground early.  In a Zero Drop shoe, the foot tends to approach the ground more parallel to the ground and land the way they would naturally if they didn’t have a shoe on.   In most runners, this effectively limits overstriding and improves running technique immediately.

3c) IT Band Strap: These straps are placed above the knee and change the point of tension on the IT Band.  In many runners they are effective at reducing the pain.  In most situations, an IT Band strap reduces discomfort but doesn’t necessarily help the injury to get better.

Medical Breakdown: http://emedicine.medscape.com/article/1250716-overview

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Heel Pain when you wake up? Here’s a 3 step approach to treating Plantar Fasciitis

Do you have heel pain when you first wake up in the morning? Is that first step just a killer? Plantar Fasciitis is a common running injury and is also common among people who spend a lot of time on their feet in shoes. Where it isn’t common is among habitual barefoot populations…in fact, it doesn’t exist among people that don’t wear shoes. In 18 years of working with people with Plantar Fasciitis, I’ve seen a good deal of what works and what doesn’t. There doesn’t seem to be any magic bullet. Sure, getting arch supports or wearing a night splint may provide some immediate relief, but they often don’t end up being a long term solution. Despite what many believe, it can be cured long term, it just takes a bit of commitment…

Plantar Fasciitis Treatment

Step 1) Reduce Inflammation

• Ice (Rolling a frozen Dixie cup works well)
• Topical Anti-Inflammatory, preferably Myomed
• Anti-Inflammatory
• Soft Arch Supports (When not strengthening)

Step 2) Break Up Scar Tissue/Stretch

• Deep tissue massage every 3rd day
• Roll a Foot Rubz ball (preferable) or Golf/Tennis Ball regularly
• Stretch Calves & Feet (Lots of stretches on the internet)

Step 3) Strengthen (Most Important Part)

• Start with 30 seconds of barefoot running/walking on soft/natural surfaces and add 30 seconds every day or 2 (Probably the single most effective way to eradicate PF; subtract this time from your regular workout, i.e. 30 Minute Regular Workout = 29 minutes in shoes, 1 minute barefoot)
• Pull in a towel w/toes and repeat
• Pick up marbles w/toes and spell alphabet
• Stand on one foot (affected foot)
  • 1) Waiting in line, standing at work, whenever, wherever
  • 2) As an exercise: barefoot eyes closed on carpet

Notes: The goal is to inversely fade out the need for support while slowly fading in foot strengthening, thus making the foot strong and independent.
Stay away from being barefoot on hard, flat, surfaces, etc. until feet are strong enough to handle it.
Feet have been weakened by years of shoes and arch support, it will take some time to get feet strong enough to reverse those effects.
In many people, devices like the Strassburg Sock drastically reduce the “first step in the morning” pain.
Continue strengthening/barefoot running once or twice a week

In my experience, the closest thing to a magic bullet for curing this thing is the one thing my customers tell me the doctor or podiatrist never told them: strengthen your feet. In conjunction with reducing the inflammation and reducing the scar tissue that is built up as a result, making the feet strong seems to be the long term solution to curing Plantar Fasciitis. It stands to reason that if habitually barefoot people don’t experience Plantar Fasciitis while those of us with shoes and arch supports do, there has to be a reason. That reason is likely that their feet are strong while ours are weak.
In theory, wearing shoes and arch supports do for our feet what our feet should be doing for themselves, which ultimately ends up weakening our feet. As our feet become weaker, we need more and more support, and a cycle of dependence is in place. This is the reason people may feel some relief when getting arch supports or orthotics, but a few months to a few years later, the pain comes back worse than ever. I rarely meet customers who love their orthotics, and even those that say they like them admit that they are dependent on them and wish they didn’t “have to” wear them. In essence, they don’t. Even dependence on arch support can be reduced by returning the feet to their natural state by making them strong. To say that we “need” support is to argue that we weren’t created right or that evolution didn’t work.
Returning our feet to a more natural state by reducing the inflammation that has built up, breaking up the scar tissue, and then strengthening the feet will have very positive effects with arch and heel pain and throughout the body.

K. Golden Harper, Runner’s Corner – Orem, Utah

$5 Running Technique Class – 2nd Wednesday of Januaray @ 7pm (Call 223-7010 to sign up)