The knee is often a common site of injury associated with running and one of the most common conditions is Iliotibial Band Syndrome (ITBS).
Personal trainers who train clients who are runners may come across ITBS, or indeed other injuries, quite frequently and it is essential that we know how to work with our personal training clients to minimise the risk of developing ITBS or have the knowledge to perform any corrective exercises should it occur. Our Running Conditioning and Biomechanics Course covers Gait Analysis in addition to studying rehabilitation exercises, but we thought we would share some exercises on this blog with you.
Research has shown that ITBS actually accounts for 12% of all running related injuries. The condition is influenced by numerous factors such as:
• Increased mileage
• Increase in training volume
• Running on uneven surfaces
• Excessive pronation
• Hip abductor weakness
The tensor fascia latae begins on the proximal iliac crest and connects with the posterior gluteus maximus to form the ITB. The ITB is a thick band of fibrous tissue that runs from the lateral hip to the lateral knee and can become irritated due to friction when the band crosses over the lateral femoral condyle, mainly during 30° of flexion.
Causes of ITBS:
1. Muscle imbalances – during running the quads and the hamstrings contract so frequently that the gluteus medius becomes weak. Because running occurs primarily in the sagittal plane the muscles that work in the frontal plane (hip abductors) are not strengthened during running, leading to weakness within the hip abductors. The gluteus medius has to exert a force three times the body weight in order to counteract movement of the pelvis to maintain alignment during running.
2. Movement of the ITB over the femoral condyle – as the knee extends and flexes the ITB moves anteriorly and posteriorly over the lateral femoral condyle. This can lead to irritation as it continually slides over the condyle. During running, the femur adducts compared with the pelvis during foot contact. At this point, the gluteus medius and tensor fascia latae are working eccentrically, then work concentrically during the support phase. Athletes with weak gluteus medius muscles are more likely to adduct and internally rotate during midstance of the running gait, which in turn increases the amount of friction.
Pre-habilitation work
To help prevent the onset of ITBS or if the client has developed ITBS the focus of training should be to strengthen the gluteus medius and lengthen the ITB.
Strengthening Exercises:
• Hip Hike – Have the client stand on the edge of a box 4–6 inches in height with the majority of body weight on the unaffected side. The athlete will lower the involved hip and then bring it back to neutral. Begin with 2 sets of 10 reps and progress to 3 sets of 15 reps.
• Clams – Place the client in a side-lying position with knees flexed to 90°. The athlete will then abduct and adduct the hip (acting like a clam opening and closing). Begin with 2 sets of 15 repetitions and increase to 3 sets of 20 repetitions. Add resistance as they progress by using a resistance band or applying direct pressure to the lateral aspect of the knee.
• Step downs – Have the client stand on a step about 6 inches in height. Have the client step down with the uninvolved knee while keeping the involved knee over the second toe. Begin with 2 sets of 10 reps and progress to 3 sets of 15 reps.
• Lateral Monster Walks – Attach an elastic band around lateral portion of both ankles. Flex knees and hips and proceed to side step. Ensure that both knees and hips are remaining flexed and not extending as the gluteus complex becomes fatigued. Begin with 2 sets of 10–15 yd (Figure 1 below).
Stretching guidelines – (Journal of strength and conditioning 2013)
By incorporating these stretch and strengthening exercises into any runners training we can play an active role in decreasing the likelihood of the client developing ITBS, helping them achieve their goals on time and decreasing missed sessions due to injury.
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