ITB Syndrome is an irritation of the fibrous tissue that runs along the outside of one or both legs, and the resulting pain, usually felt to the side or just above the knee, is an uninvited guest who stubbornly resists departure.

Tell a fellow runner you’re sidelined due to ITB syndrome, and you’ll typically receive groans of commiseration: “Is there anything I can do? Where can I send a bouquet of flowers?”

Hand me a tissue

“It’s not a tendon; it’s really a strip of tissue,” said Amy Arundale, formerly an elite soccer player and now a physical therapist with Proaxis Therapy in Carrboro.

“The best analogy to it is to look at it like a strap on a backpack,” Arundale explained. “It’s about an inch or one-and-a-half inches wide, maybe a centimeter thick, and it’s got a little give, but not a lot. It doesn’t contract like a muscle, but it gets pulled on by the muscles attached to it, and it gets tight when the muscles pulling on it up in your hip are tight.”

Like Plantar Fasciitis, it is among the most common overuse injuries among runners, but because of the typical location on the outside of the upper leg, many people mistake ITB Syndrome for a knee injury, Marlene Cimons wrote for RunnersWorld.com.

“The pain may be in the knee, but it also may be tender all the way up the IT band,” Arundale said. “If the pain’s on the outside of the knee where the IT Band comes down and there’s a lot of inflammation, we may say that’s the problem, but if it’s over toward the front of the knee, we may look at other causes.”

Cause and Defect

“ITB syndrome can result from any activity that causes the leg to turn inward repeatedly, including running in older shoes, running downhill or on banked surfaces, or running too many track workouts in the same direction,” Cimons noted.

Arundale added that a glitch or imbalance in running form can also contribute to the problems.

“Having someone watch your run — either someone in physical therapy, someone from one of the running stores, or just having a friend watch your run — if there’s something contributing blatantly obvious like a limp or one foot landing louder than the other, they may point it out,” she said.

Quinn added that pronation of the foot, leg length discrepancy, bowed legs, or a general lack of flexibility in the gluteal (buttock) or quadriceps (thigh) muscles may increase the risk.

While faulty biomechanics can lead to ITB syndrome, so can temperament. The most common causes of ITB problems are the Terrible Too’s: too much, too soon, or too rigorous.

“One of the things we talk about is mileage — especially for those who’ve recently ramped up their mileage really quickly,” Arundale, who said programs which gradually build strength and distance are far preferable to rigorous running on a regular basis.

“Footwear is another problem,” she added. “Shoes break down in around three months (or less), especially if people are wearing them throughout the day and to go running.

Arundale said there was a difference between the shoes being sold at athletics specialty stores and those at basic shoe stores.

“There’s a price difference,” she said, “and it has to do with the quality of the materials.”

The “rest” is silence

When most runners first identify their discomfort as ITB Syndrome, the first emanation may be a string of four-letter words. Ironically, the first word in remedies comes as a four-letter word that is the nastiest utterance in a runner’s vocabulary: “rest.”

“Once you notice ITB pain, the best way to get rid of it for good is to rest immediately,” Cimons said. “That means fewer miles or no running at all. … You can cross-train though. Swimming, pool running, cycling, and rowing are all fine.”

Physical therapy is also highly effective for most who suffer.

“The deep tissue work helps break up adhesions around the ITB, but it also helps the muscles in those areas relax,” Arundale said. “Also, rubs with cups of ice (fill some Dixie Cups with water and freeze them) are great, and because the IT Band is so close to the skin, ice massage is really effective. Foam rollers are one of the most effective pain relieving tools.”

If ITB Syndrome isn’t addressed early, however, more radical treatments may be indicated, including ultrasound or topical cortisone.

“The last resort is surgery, Cimons explained, but this approach can leave knees weaker, which is rarely an accepted outcome for runners and athletes.

Attention to prevention

A car commercial once explained that the best way to avoid getting injured in an automobile accident is to avoid it in the first place, and such is the case with ITB Syndrome.

Methods of prevention in training include proper stretching and warm-ups, a sufficient degree of rest, and only gradual increases in speed and mileage.

Where workouts are conducted can go a long way toward remaining healthy as well. Running toward the middle of (less-traveled) roads can decrease an imbalance in the gait, and forsaking roads for trails will vary the repetitive footprint. When running on tracks, alter directions so as to vary the leg that is stressed.

Proper equipment in shoes and orthotics, when needed, can reduce vulnerability.

Even with the best preventative measures, however, many runners may still find themselves victims of the dreaded ITB Syndrome, as sure as it’s some running rite of passage. The good news is that, recognized very early, the runners can completely rid themselves of symptoms.

The bad news? Fewer bouquets of flowers.