For many runners the most intimate relationship they have outside of wedlock and with their masseuse is with a solid cylinder of foam. This foam roller is diligently rolled over by thousands of runners each day as a means to ease their diabolical suffering cause by iliotibial band syndrome.
Like most running remedies it hurts bad, but runners being the masochistic bunch we are, will endure such suffering to keep ourselves on the road and in within touching distance of our next big goal. ITB pain … I will ignore and run through this minor ailment! That is until it stops you running.
But you know what the problem with the foam roller is? It’s a treatment, not a cure and a pretty average remedy at that, because the composition and situation of the iliotibial band within the body makes it devilishly hard to massage and stretch to good effect. And worse, the next time you head out and run, your ITB sourced knee pain returns with a vengeance, perhaps not in the first mile or two, but as you push through thirty minutes of running it’s hello pain.
Your source of comfort? Foam roller, an unsympathetic and hurtful companion. Like a bad friend or destructive relationship of any kind, perhaps it’s time you broke up? Maybe you’re ready to say those words “foam roller it is over.”
So what causes ITB syndrome and that crippling knee pain?
Traditional thought would have it that the pain is caused by friction between the tough ITB and a bony protuberance on the outside of the knee. This may well be true, but in day to day business the ITB doesn’t act up unless there is something going on that causes it to tighten up or become inflamed – so all that foam rolling is just treating the symptoms not the cause. The reason your ITB is inflamed is because of the way you run.
As I’ve covered in a previous post about the running injury equation, most running injuries are overuse type afflictions. This generally comes about by either overusing the muscle in a role it’s not designed for, or overstretching it because your body has inherent weakness or instability that pushes the impacted area outside its normal range of motion.
I don’t know in what proportion ITB pain is caused by overuse or by overstretch and it doesn’t really matter, because the two in this case are so closely interrelated that you attack this injury as if both are playing a role in causing your pain – and they probably do, here’s why:
ITB pain caused by overuse of the TFL
ITB pain and iliotiobal band syndrome has been commonly linked to over activity in the TFL (Tensor Fascia Lata) muscle or the Late muscle as it’s otherwise known in coffee drinking circles. The TFL in running plays a role in helping retrieve the leg from behind the body (through pre-stretch) and then send it forwards into hip flexion (knees ahead of the body). Many runners trigger the leg retrieval and hip fexion impulse too early because their glutes and hamstrings are not strong enough to give you a decent hip extension and pop forwards into the next stride.
How do I know this? I used to run this way and in the coaching work I have been doing throughout this year it has been a consistent pattern again and again, especially among recreational runners. For those of you who’ve yet to sit through the misfortune of looking at my old running technique, here we go again. Note: some of that purposeful thrusting forwards is coming via the TFL.
ITB pain caused by overstretch through internal rotation of the thigh
Runners that don’t have the strength or control over their glute max and the entire buttocks complex can allow the thigh to rotate inwards, because there is insufficient power being applied or resistance being given from the hip abductors and external rotators (your butt). The knee collapses inwards and the ITB is over stretched with every stride.
The shape of the glute max gives you the clue, those fibers are wrapping around the hip from side to back, they help you extend the hip, but also provide the external rotation impulse that keeps the thigh in proper alignment with the hip and not collapsing inwards. If you want to go to school on running and how important I think glute max is to the process you can check out my book for a lot more analysis of how the bum works in running.
Example of thigh rotating inwards on contact
Sorry, you’ll have to look at me again. I’m not sure why I’m covered in so much black marker, but it does serve to highlight some of the instability I’ve written about in this article.
ITB pain from walking – what does this tell us about our running?
Two of the worst bouts of ITB pain that I have experienced were brought on by sustained periods of walking. I walked as I used to run, all quads and hip flexors, no bum or hamstrings. Combining all the elements we’ve just covered, overusing the TFL and collapsing through the hips. One reason why so many runners struggle with ITB pain is the startling similarity (in terms of muscle activation patterns) between their running technique and their walking gait. If you do as I did, which was to maintain the same pattern, but just speed it up when you’re running, you’re asking for trouble.
The facts: how to cure ITB syndrome – strength training
— Alex Hutchinson (@sweatscience) June 27, 2012
So setting aside my own theories about how you ended up with an ITB injury, there is little doubting the research I came across when putting my book together. A number of studies have shown that improving hip abductor and external rotator strength and activation can resolve ITB injuries. So you don’t even need to be a big believer in working on running form, you just need to get stronger around the buttocks.
If you can’t stand on one leg with your knee very slightly flexed without your knee cap dipping inside the line of your big toe, then you need to strengthen and learn to activate your buttock muscles. If you don’t do this there is a greater risk of injuries developing down the track.
Find out how to be the first of your running buddies to break up with your foam roller by reading these articles below and/or visiting the strength training program:
Written by Brian Martin