ITBS (Illio Tibial Band Syndrome) is not IBS (Irritable Bowel Syndrome), but it is Irritable

By Emma Maaranen

ITBS is a repetitive stress injury common to both runners and cyclists.  If you participate in either of these sports, either you or your training partners have likely experienced this injury.  ITBS is characterized by pain on the outside of the knee.  Unless you have experienced knee trauma recently, ITBS is most likely the sports injury you are dealing with, not a torn meniscus or knee ligament.

What is the ITB?

ITB anatomyThe ITB (Illio Tibial Band) is a long tendon (rubber-band like structure that connects muscle to bone) that runs on the outside of the thigh from the hip the knee.  The Gluteus Maximus and Tensor Fascia Latta are the muscles that connect to the ITB.  These muscles make a fan shape between the outside top of your pelvis (if you put your hands on your hips, they span from your index finger to thumb), and they narrow to the bony spot at the top outside of your thigh.  (Insert image here) The ITB starts at the bottom of this fan shape and travels down the outside of the thigh.  It then crosses the knee and inserts just below the knee on the outside of the tibia (lower leg bone). The ITB separates the quadriceps (front thigh muscles) from the hamstrings (back of thigh muscles).  If you have ITBS, pain is felt just above the outside of the knee.

How did this happen?

Most of us do sports that move forward and have little side-to-side motion with the legs.  Over time forward only motion weakens the muscles of the ITB.  To walk, run or to pedal these muscles work in a small range of motion, which trains the muscles to be strong only in a small zone and causes a loss of flexibility.  Sudden increases in training distance or intensity, as well as adding steep hills into run training, can overtax these muscles and tighten them.  This creates excessive tension in the ITB and begins to cause friction at the lateral epicondyle (the bony knob at the outside bottom of the thigh bone).  When you bend your knee about 30 degrees the ITB normally glides over this bony knob, but if it is too tight the ITB grates over it and gets irritated.  Once inflamed, the ITB becomes swollen and will grind over the lateral epicondyle more, making the condition worse as you push through the pain!

You have pain at the outside of your knee; what do you do?

The first time you experience pain at the outside of the knee it is important to end your workout.  Go home and ice the painful area.  Rest and ice for three days (no running/hiking/biking; avoid stairs and other activities that involve repetitive bending of the knee).  After three days, see how it feels.  A minor one-time irritation of the ITB should recover after this rest period, but be on notice that you need to strengthen and lengthen the muscles of the ITB.

If, however, three days of gentle care for your inflamed ITB does not alleviate the pain, you most likely have ITBS.  ITBS is a fancy tendonitis.  For it to heal, you will not only have to address the inflamed tendon, but you will have to address the cause of the excessive tension in the ITB as well.  The cause is often a combination of weak/tight ITB muscles, adhesions along the ITB to the quads and hamstrings, muscular or structural imbalances in the pelvis/hip complex, and foot/ankle biomechanics. Cyclists need to make sure they are not in excessive toe-in position when clipped in and runners should replace their running shoes if they have over 250 miles on them.

At Focus Bodywork we can help you sleuth the factors in your ITBS, address adhesions in the ITB, treat the associated muscles and recommend self-care practices.  Occasionally ITBS is stubborn and needs a physician’s care.  In these cases you may need a cortisone injection, orthotics or a regiment prescribed by a physical therapist.  We are happy to recommend some fantastic practitioners for you to work with and be a part of your return-to-play team.

In our next post we will cover self-care for ITB health.

In 2012 I’m Going to Eat More Cookies… For My Health!

By Emma Maaranen

2012 is just around the corner. Although I don’t make resolutions per se, I do use the anticipation of a new calendar to plan out my training and race schedules and to revise repeat plans based on the successes (and failures) of last year. I also can’t help but reflect on the numbers on the scale and fantasize about the rewards of being two pounds lighter, decreasing my body fat by 1%, shaving 5 seconds off my marathon time, completing the Mid-Week Mountain Bike Race Series, and waiting for the boys at the ridge line on a dawn patrol.

As I plan out my 2012 calendar, I also page through the recent edition of my favorite journal, The Physician and Sports Medicine, which has several articles on osteoarthritis (OA). Several research studies note a fact I hate to dwell on: women athletes (especially those with a history of knee injuries) have a higher risk of developing OA than men and their sedentary counterparts. The usual excuses are noted in each article: women have a greater angle of the femur (thigh bone) from the hip to knee due to a wide pelvis; women are small and therefore have small knees unable to absorb as much force as larger ones; and women have lower bone mineral density (BMD), which is currently believed to be the greatest indicator of OA likelihood.

I cannot change my womanly curves, nor can I double the size of my knees, but I can address my BMD. Glazed over and tip-toed around in literature regarding women athletes is a dirty word: anorexia. In the culture of athletes, being too thin is an obsession praised as a mark of perfect training, discipline and sacrifice for sport. But at what cost? Eating disorders are common among women athletes (and becoming more common in men). A malnourished woman will often experience amenorrhea (a pause in her fertility cycle) as the body’s way of conserving nutrients. This pause changes hormone secretion, including a decrease in estrogen levels. This decrease is a major factor in bone density loss; a low BMD means higher risk of OA.

As an aging woman athlete with a history of knee injuries, I am going to be proactive in reducing my risk of OA in my knees; I am going to accept those two extra pounds on my goal weight.  I am going to do this by not changing my eating plan (crafted by a wise nutritionist), but I am going to occasionally splurge and eat that second cookie. And, instead of feeling guilty, I’m going to tap my crumb coated fingers to my knees and say it is for them.  Here’s to a few more cookies in 2012 and healthy knees that will keep me skiing well into my 80’s!

“Running will ruin your knees” – maybe not so…

By Emma Maaranen

Today the Wasatch 100 ultra marathon started and many of the Focus Bodywork community are running or pacing for this event.  Over coffee this morning I overheard some ladies mocking the competitors, stating, “They are ruining their knees, none of [them] will be able to walk when they are in their 70’s.” Let’s debunk this notion. When comparing the knees of seniors over a 10-year period (age ranges from 50-80, in 10-year increments) who live a sedentary lifestyle, who run an average of 20 miles a week, and those who live active life styles (elevated heart rate for an hour at least five days a week), it was found that the most degeneration of knee joint tissues were in the sedentary population.  As one would expect, mild changes were seen in the active group, but surprisingly the running population showed increased health of their knees over the 10 year period!  Source: Long Distance Running and Knee Osteoarthritis When researchers looked at seven marathoners over a 10-year period, they found only one study participant who experienced significant degeneration of his knees, which lead him to quit running during the study.  However, he had a significant preexisting knee pathology prior to the study and quit running mid-way through the 10-year study period.  The other six runners showed no signs of new damage to their knees during the study period.  Source: Knee Joints of Runners These are just two recent studies, and more data is needed to confirm that running is, in fact, good for your knees, but as a runner myself this gives me and my knees hope.  The message here is that if your knees are healthy, there is no reason to expect they will deteriorate under thoughtful run training over a lifetime.  An active knee is more likely to stay healthy as you age than a sedentary one.  And maybe, just maybe, running will reduce your chances or severity of osteoarthritis as you age.  Of course, if you have significant knee history, running may not be the best choice for you. So cheer on all the ultra marathoners out there tonight running up and over the Wasatch Mountains who inspire our athletic spirits and may be adding to the well-being of their knees while they do it.