Our Old Friend the IT-Band

Most people wouldn't know what the iliotibial band is until they injured it. But once they do, the pain can stop avid runners and other athletes in their tracks.

Your IT bands, as they are commonly called, start at the hips, run along the outside of the thighs and attach on the outside of the knees.

IT band injuries are the second-most-common injuries among runners behind patellar tendinitis, damage to the tendon that connects the kneecap and the shinbone.

A slew of problems can contribute to IT band friction syndrome, including weak butt muscles, over-pronation of the foot (putting more weight on the outside of the foot), flat feet and having one leg longer than the other, said Dr. Michael Jonesco, a sports-medicine physician at Ohio State University Medical Center.

"Typically, I consider this an overuse injury that's common in runners and cyclists," he said.

During exercise, the IT band rubs across the outside of the knee, causing inflammation. This repetitive movement can cause the tissue to grow thick and become tight, said Tammy Garwick, an exercise physiologist at Mount Carmel Cardiac Rehabilitation in Westerville.

"A lot of times, you can't feel it when you start running, because it's a rub-rub-rub, but sometimes it will be so bad, you can't continue," said Dr. Joseph Ruane, medical director of the OhioHealth Spine, Sport & Joint Center.

"You can feel the pain from it mostly on the outside of the knee, but because it is one continuous band of tissue, you can feel discomfort or tightness up by the hip."

Ruane said the inflammation makes people nervous because they think it's a knee injury, "But it's one of the easier conditions to treat with ice, anti-inflammatories (drugs) and strengthening."

Anne Marie Beinecke injured the IT band on her right leg. She said she likely did it in January while playing back-to-back soccer games.

She didn't let the tenderness and tightness stop her daily runs. But that ended last month.

"I went on a 5-mile run on Thanksgiving Day and experienced some pretty severe swelling on my right knee," said Beinecke, a Columbus chiropractor. "I should take my own advice, but I ignored it. I didn't stretch, and I continued to run."

She went to see Ruane, stopped running for about 10 days to reduce the swelling and has added about 10 minutes of stretching to her post-run routine.

"I really was not focused on the IT band," said Beinecke, 37. "I was focused on the quadriceps, hamstrings and the calf muscles."

It was probably four years ago when Sara Garverick believes she first injured the IT band in her left leg. She runs 3 to 5 miles a day and stopped running briefly when the pain started in 2007.

She eventually started running again, continuing through the pain, and probably started favoring that leg. In turn, her right leg began to hurt. She went to Dr. Jonesco, who took X-rays and analyzed the way she ran to identify the IT band injury.

"He said, 'If we fix the left leg, we'll fix it all,' " said Garverick, 30.

The Lewis Center resident has been walking on a treadmill and doing exercises to strengthen her hips. She's eager to run outside again.

"Walking in the gym gets really old," Garverick said.

Experts say there are several methods to prevent and treat IT band injuries, including stretching, massage and large foam rollers.

The rollers resemble the foam "noodles" you see kids floating on in swimming pools. The ones sports medicine experts prescribe are 6 inches thick and much firmer.

You roll your tight body parts over the roller to loosen the areas and stretch the tough, fibrous tissues. The exercises might be painful at first, but once the tissue loosens, it won't hurt as much, Garwick said.

"The foam roller is popular because you can exercise (the IT band) before it becomes tight," she said. "It's not something that can be stretched easily, like a quad or hamstring."

Keeping your core muscles -- abdomen and back -- strong will help keep your body in balance and reduce the risk of injuring an IT band. But if you do, your doctor or physical therapist will try to figure out how it happened.

"We go beyond treating the injury and figure out why you're having it; patients with hip weakness and over-pronation at the ankle are more predisposed to this," Jonesco said.

Things that can help prevent the injury include orthotics, exercises to strengthen the hips or a gait analysis, during which an expert assesses the way you walk or run to correct posture or movement problems.

"It's taking you through the cycle of your run from heel strike to the extension of the opposite leg looking at all the things a runner does while they run," he said.