Iliotibial Band Syndrome and Marathon Training

Iliotibial Band Syndrome

Are you training for a marathon and battling iliotibial band syndrome (ITBS)?

I did not have any iliotibial band problems until I significantly bumped up the duration of my long Sunday training runs.  I ran for 2 hours for the first time without any problems, yet the following week when my goal was to run for 2 hours and 20 minutes, I was forced to stop at just over an hour.  The pain on the outside of my right knee started as a slight burning sensation and progressively worsened and eventually, I was forced to stop.  I was gutted.  What was the problem….I have a marathon to run in three months!  I had never had knee problems in the past so this was quite worrisome.  If I can’t run for over two hours and lack the running talent of Haile Gebrselassie (the current world record holder in the marathon with a ridiculous time of two hours, four minutes and 26 seconds), how I am I going to run a marathon!

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Be Proactive When Training for a Marathon

At the onset of my marathon training I made a decision to book weekly physiotherapy appointments for two reasons (for any first time marathoners I highly recommend you do the same).  Firstly, I wanted to approach my marathon training with a proactive mindset in order to address such things as muscle imbalances, tight muscles, improper shoes and running biomechanics from the onset of my marathon training.  Secondly, for any injuries that did develop I wanted to address them as soon as possible so not to interrupt my training program.

When I explained to my physiotherapist what my symptoms were, he was very quick to point to my iliotibial band as the problem. The iliotibial band is a thick band of tissue that runs down the outside of the thigh and plays an integral part of stabilizing the knee when running.  What many runners do not realize however, is that the iliotibial band inserts just below the outside of the knee, exactly where my pain was.  When running, there is constant rubbing of the iliotibial band over the bones on the outside of the knee which can cause inflammation in the area and thus it becomes painful.

Iliotibial Band Syndrome Guidance From My Physiotherapist

“Where did I go wrong and how do I get rid of this”, I said to my physiotherapist.  While there are many potential causes of iliotibial band syndrome, I ran too far, too soon.  Some say that the hardest part of running a marathon is not the marathon itself, it’s the training. Pounding the pavement hard for 12 weeks takes its toll on the body.  You have to respect the distance and the volume of training that is required.

How did I get rid of this incredibly annoying running injury?  First and foremost, I had to cut back my training until I had the iliotibial band syndrome under control.  Secondly, I needed to increase the strength of my hip abductors (the muscles that help keep the legs out, away from the body) when walking or running.  Hip abductors are typically weak in long distance runners.  When they are weak, the iliotibial band gets overworked when the hip is abducting.  It is therefore, vital that these muscles (and other stabilizing muscles) are strengthened to an adequate level to take the burden off the iliotibial band.  One of my favorite exercises to do this is the side plank (see the photo below).  Try holding this position for 20-30 seconds on each side, while trying not to let your hips sag towards the floor.

side plank

Lastly, I regularly used a foam roller and The Stick (I purchased for traveling as it easily fits in a backpack) to break up any myofascial adhesions and generally loosen my iliotibial bands.  Using either are simple and effective ways to increase flexibility and loosen tight muscles.

Within a couple of weeks, I was back running up to two hours with no knee pain!  I continued to use the foam roller and was vigilant about regularly performing my hip abductor exercises for the remainder of my marathon-training program.  The result was not a pain-free marathon (does that exist?), but an iliotibial band pain-free marathon!

How do you prevent Iliotibial Band Syndrome?

  1. ensure a proper warm-up before runs – this may include walking for five minutes before starting your run
  2. replace your worn-out running shoes
  3. be proactive – stretch and use a foam roller regularly (see video below)
  4. build up your mileage slowly
  5. perform exercises such as the side plank and side-lying hip abduction (see video below) to increase the strength of your hip abductors

Foam Roller Exercise

Sidelying Hip Abduction Exercise

Foam rollers are available from Amazon.

Other resources: Foam roller exercises for tight muscles

  • Jessica Cummings

    This article was so helpful and encouraging! It’s been 5 grueling months of dealing with my IT pain, physical therapy and worse, little running. I miss running and hope with this advice (mainly a strict abductor exercise regimine), I will be stocking up the miles in no time! Thanks for the “happy ending”!

  • Ken Zelez

    This one of the best posts I have read on ITBS!