ITB injuries are a common problem we see in our clinics especially when runners or cyclists are training for a race.
This normally presents itself as a vague pain or extreme tightness down the outside of the thigh, either after finishing an exercise session or towards the end of a session.
Similarly to shin splints this injury is more likely to happen when increasing the amount of exercise being done. It’s why marathons, 10ks, Tough Mudders and The Big Cycle tend to result in busier clinics for us at JMC Physiocures, as people regularly pick these injuries up during training.
What is the IT band and what does it do?
ITB stands for Iliotibial band meaning it is a band which connects the ilium (crest of the pelvis) and the tibia (shin bone forming part of the knee). It also has attachments to other muscles such as quadriceps and hamstrings. Although there is some debate in physiotherapy about the range of functions of the ITB, its main purpose is to support the pelvis when standing to allow the opposite leg to swing through. It does this by pulling on the pelvis along with the gluteal muscles to lift the opposite side of the pelvis.
As you can imagine if you are training for a marathon or doing the Edinburgh to Glasgow cycle, this movement is repeated multiple times. If this gets inflamed or aggravated then it becomes increasingly difficult to keep exercising.
What causes it?
An exact cause for ITB syndrome or an agreed test/set of symptoms has yet to be identified. A sudden increase in training frequency or intensity appears to be linked with it. In my opinion, this problem typically comes with a muscle imbalance of the muscles of the hips and knees. I don’t like to use the term muscle weakness for this as the majority of people I see with ITB problems are fit and exercise regularly meaning they could not be described as weak.
The muscle imbalance can come from focusing on one type of exercise and forgetting to balance this out by working the opposing muscles. As all muscles have an opposite muscle which pulls against them; if one is stronger than the other this can lead to pain. This can prove difficult to manage as a number of sports require a slight muscle imbalance to improve performance, think of Andy Murray’s shoulder and the force he needs to generate forward compared to how much he has to move backwards. If the training programme is correct, balanced, and spread over the appropriate period of time then muscle imbalance can be a positive. If you are confused then welcome to the world of physio!
How do I treat it?
As with all injuries prevention is better than cure. If you are planning to enter a race which is longer than you are used to, or if you are trying to improve your times (See our blog on marginal gains 😉) then starting with a well-thought out training plan is essential. This should allow you enough time to gradually increase your distance, load (resistance) or speed without any sudden changes. It is also important to consider how you will vary your training by introducing rest days, weight training for a variety of muscle groups, interval/speed work and possibly even yoga/pilates style gentle exercises.
Form is temporary class is permanent
For most sports I would say that getting your “form” or technique right is vital. Ensure your technique and equipment is right before starting any training. Ask a cycling club about your bike set-up, invest in new footwear, or speak to a running club about your running style.
If you are reading this because it is too late and you already have some pain then there is some good and bad news.
The good news is that it will get better, total rest isn’t likely to help and your physio can provide advice and treatment.
The bad news is that this will probably mean altering your current training schedule to reduce the exposure and will require an effort from you to work on exercises to address any imbalances.
There are also a number of techniques that your physio can use such as massage, mobilisations, and acupuncture which may provide some short term relief although the priority is to get your exercise regime correct.
If you have any questions or would like an assessment for thigh pain then please get in touch with us at www.jmcphysiocures.co.uk or by calling 01236 425 661 to book an appointment in Lanarkshire today.