ITBS Here, ITBS There, ITBS Everywhere!!

There is an old trick for treating ITBS that I learned from Florence Kendall. Sometimes we mistake tautness for tightness. The ITB is not really tight but rather being pulled taut because the opposite leg is either anatomically or functionaly slightly shorter than the involved leg. To both diagnose and treat the problem Florence would put a heel lift in the opposite shoe. Often, although of course not always, that relieved the symptoms. Even if that relieved the symtoms further full biomechanical assessment and treatment was still done to correct any dysfunction that may have led to the problem in the first place.

NY Sports Med’s patient population includes a high number of runners and triathletes. As a sports medicine physician, I see an extensive number of patients with ITB insertional friction syndrome, particularly in patients that are increasing their mileage. In order to resolve the condition and prevent re-occurrence of the condition, patients have to put the time into stretching. With the NYC Marathon approaching, I perform a number of corticosteroid injection to the distal ITB so that the athlete

At NY Sports Med, we have a very high patient volume of runners and triathletes with insertional ITB friction syndrome. Athletes have to put the time in and do the work with their therapists to stretch the ITB and make biomechanical changes. If an athlete is close to competition time and is suffering, I do perform corticosteroid injections to allow the athlete to compete. If we have time, then aggressive stretching exercises and correction of related biomechanics factors are necessary to resolve the issue and prevent reoccurrence. The exercises do need to be incorporated into an almost daily HEP as the condition has a high rate of re-occurrence.

Michael
How long do you have them avoid running after a coricostroid injection? I go 3 weeks.

Almost to a person, the similarities in ITBS are the following: tight TFL on the symptomatic leg, opposite side QL tightness (usually super painful with minor palpation), poor glute function and poor scapular retraction/depression.

Usually I will start by MFR to the TFL, QL, and ITB. Although the ITB won’t “stretch” like a muscle, I work the client up to a PVC pipe to roll on. This usually brings the fastest overall relief (although very painful during).

As far as exercises I would do an active warm-up re-integrating the new ROMs of the hip and then 5 sets of bridges to engage the glutes. Usually then proceed to rack pulls or pull through (watch for full hip extension, most ITB people won’t get it unless cued). To finishing the workout they will perform T’s and Y’s on a ball and some form of core stability and rolling pattern.

I found that working on the ITB itself was not as effective as working on the vastus lateralis. the VL, with its fascial connections to the ITB, taughtens the ITB before its proximal attachments (glut med, TFL, glut max) fire. With some direct myofascial stokes to the VL both anteriorly and posteriorly to the ITB we can decrease the resting “pull” on the ITB via VL.

Believe it or not, I learned this trick during a break at an NAIOMT course several years ago and it works like a charm. I take a sink plunger and lots of US gel and do a kind of reverse MFR along the TFL, ITB, VL and BF, sometimes even along the peroneals. It’s painful, but a lot less painful than pressure releases like foam rolling (I know, I’ve had ITBS during marathon training). If the patient has adhesions (usually proximal third of ITB), they will often get petechial or even frank brusing the first few times. I usually only need to “plunger” 3-4 times and know when to stop when I can no longer maintain suction along the entire lateral leg. Warning: wear a gown or you’ll end up covered in US gel.