If you often say, "Ow, my knee!" you may suffer from IT Band Syndrome. Unfortunately, this is one injury that won't go away by itself. But there is hope and you don't have to give up running.

Iliotibial Band Friction Syndrome, ITB syndrome or just "Ow, my knee!" No matter what you call it, it can be a pain in more than your knee. This syndrome is characterized by symptoms on the outer aspect (lateral side) of the knee joint.

As with many of the overuse or repetitive trauma injuries suffered by runners and triathletes, it usually starts out as stiffness with pain after longer or more intense efforts. This progresses into increased discomfort after less effort and may get to a point where you need to alter your activities. The pain then becomes more apparent while ascending and descending stairs.

ITB Syndrome can also come on with a change in activity type or terrain. I've had very physically fit patients come in with this during one of their recovery weeks because instead of pounding the pavement, they went for a hike with a day pack on steep descents.

The iliotibial band is a band of connective tissue that runs down the outside of the thigh from the hip to just below the knee. Pulling on the band by the muscles of the hip helps tighten the tissue along the length of the leg, thus providing support for the lateral aspect of the knee. The band passes over a bump on the outside of the femur (upper leg bone) just above the knee. When the controlling muscles tighten the pull on the band, it rubs against this bump and becomes irritated.

When sprinting, our knee flexes more than 35 degrees, which takes the band off this bump; distance running requires only about 35 degrees of flexion, thereby causing more potential for irritation because the band remains on the bump throughout the entire range of motion. This irritation is greatly increased as the tightness in the IT Band increases.

The big problem with ITB Syndrome is that typically IT DOESN'T GO AWAY BY ITSELF!! If you lay off running for a while it will subside, but as soon as you get to the level of effort that brought it on to begin with, it quickly returns.

Should you give up running? No! If your doctor tells you this, find a new doctor!

One factor that contributes to ITB Friction Syndrome are increased pronation (flat feet), which causes people to be more knock-kneed, thus placing increased stress on the IT Band. Make sure your running shoes provide the right amount of arch support and stability for you. Other factors are related to training errors, particularly too much distance and/or intensity too soon, as well as increased hill running (especially descending).

There is hope. Part of the problem is that with the inflammation that accompanies this injury, the band adheres to the underlying muscle tissue, affecting its function. Soft tissue mobilization (aka. evil, deep tissue massage) will help break up the adhesions and allow you to get the most from your stretching routine.

Self-massage can be performed on a foam roll which can be purchased from performbetter.com. Start with rolling back and forth on the foam roll for 30-60 seconds every other day for the first one to two weeks, then progress to everyday thereafter as needed (see First Picture).

Stretches for the IT Band involve the muscles at the hip that control the tension in the band (Mainly the TFL). The following stretch will work well and should be performed three to five times per day and held for 30 seconds, one repetition, as well as after training.

For the right TFL, lie on your back with knees bent, cross your left knee over your right, pulling your right knee to the left. You should feel the stretch in the right hip (see Second Picture).

Another way to stretch the TFL and Piriformis muscle is to sit on the ground with your legs straight in front of you. Crossing one foot over the other leg and pulling your knee towards your chest will produce a stretch felt in the hip (see THird Picture).

Dr. Ken Sheridan is a local road and trail runner who competes in a variety of events, from marathons o duathlons. He practices at Active Care Chiropractic and Rehab in Golden. To ask him your injury questions, call 303-279-0320.