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Dr. J. on Running

Illiotibial Band Syndrome

Injury Needs Attention

Published August 16, 1999 in The Post-Standard.

By Dr Kamal Jabbour, Contributing Writer

It was a pleasant summer morning in Highland Forest. I ran joyfully in the shade of majestic pines and boisterous oaks, treading softly on an unusually dry trail. Halfway into my run, at the farthest point from my car, a gripping knee pain brought me to an immediate stop. My illiotibial band had unilaterally altered my training plan.

The illiotibial band syndrome (ITBS) is one of the worst injuries of running. It is an equal opportunity injury, afflicting elite racers and weekend runners alike. ITBS is also chronic in nature: once a victim, always a victim. Few runners ever cure their ITBS injury. We simply enjoy intervals of remission, and resign ourselves to the inevitable relapse.

The illiotibial band is the longest ligament in the human body, connecting the pelvis to the top of the tibia. The illiotibial band travels outside the knee, just above its point of attachment on the tibia. Under normal operation, it slides gracefully back and forth across the knee. Occasionally, it rubs against the knee, causing irritation, inflammation and acute pain.

Training errors are the universal cause of ITBS injuries. Running on a hard surface or the banked edge of the road, downhill running, inadequate footwear, and a sudden increase in quality and quantity are known causes of ITBS. Ice and rest are the only effective remedies. Identifying and rectifying the cause is the only sensible prevention.

I had my first encounter with ITBS five years ago. After a stressful day at work, I took to the roads to punish my body and redeem my soul. I ran towards traffic on the banked shoulder of the road, increasing my pace with every step, attacking the hills and flying downhill. When I finished, I had run my fastest 5 miles ever.

On the morning after, an acute knee pain interrupted my run after just one mile. It did not hurt when I walked, but the pain grew in intensity every time I attempted to resume running. Resigned and defeated, I walked home. The characteristic knee pain when going downstairs was unmistakable. My books on running injuries concurred in diagnosis and prognosis.

In the weeks that followed my injury, I recognized the acrobatic futility of stretching my ITB. I scratched my racing schedule for the season. I took to the flat and soft trails of the Erie Canal towpath, and limited my running to a few minutes. I learned to stop running at the first sign of discomfort, and to ice my knee after every workout.

Recovery was slow, but steady. I gradually increased the duration of my pain-free runs. I modified my training routes and times to permit running with traffic. I learned to switch sides of the road at the first hint of irritation. I appreciated the benefit of the occasional walking break, and made room in my freezer for a bag of peas to ice my knee after workouts.

Five years later, I coexist with my ITBS. My knee and I have reached an understanding. It is content as long as I run on soft trails, avoid hills, and stay away from the crown of the road. With proper preparation, I continue to train and race. I have enjoyed thousands of miles and hundreds of races.

However, my knee shows no tolerance to my adolescent impulses and excesses. My relapse at Highland Forest was evidence of its swift punishment. Without a subway to ride or a car to hitchhike, sneaker power was my only way out of the woods. I switched to the right side of the trail. I walked a few minutes to relieve my knee, then resumed running at a slower pace. I jogged the flat land and walked the hills.

Kamal Jabbour runs and writes on the hills of Pompey, New York. His RUNNING Column appears in The Post-Standard on Mondays. He maintains, the world leader in live track webcasting, and receives email at

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