In 2017, as part of my 3 year BTEC level 6 training in Advanced Clinical and Sports Massage, I conducted a research project into the effects of Clinical Massage on Iliotibial Band Syndrome (ITBS) in runners. In this post, I’m just going to give a quick review of my project and the results and some tips for dealing with it if this is something you currently struggle with.
What happened?
The short version is – massage worked!
We do have to be a bit careful in interpreting the results of research studies. In this case, I didn’t have a control group that didn’t get any treatment. This means we can’t say how much better the treatment was compared to no treatment at all. I had intended to include such a control group, but I was working with runners! Runners just want to run, I know because I am one too!
However, having said that, by the end of the 6 weeks of the trial, with one massage therapy session per week, 12 out of the 13 runners on the study were virtually pain free and back running.
What I actually did was to compare two massage protocols that were very similar, the only difference being that in one, I stopped to work Trigger Points with sustained compression (holding them until the pain eases off), and in the other I didn’t. The results were interesting to me because I fully expected the group that received extra attention to their trigger points to improve more, but in fact they didn’t – both groups improved by pretty much the same amount.
This may be because all the other techniques I used (hot stones, myofascial release, muscle stripping, soft tissue release and PNF stretching) were sufficient to deactivate trigger points. It may be that trigger points were not so important as I thought. I can’t say for sure. But the good news is that either way, the runners got out of pain.
Strengthening exercises are also important!
It’s also hard to really pin point what exactly caused improvements. Most of the runners were also doing exercises to improve strength of their hip abductors, which has been suggested by several authors to be an important factor in ITBS. (1,2,3)
In fact, in clinic, I would always prescribe strengthening exercise in addition to massage since it is important to remedy any underlying neuromuscular imbalances that may be contributing.
Too much too soon?
Another important consideration is training load. Most running injuries occur because of trying to do too much too soon. Taking a balanced approach to training is vital, especially when increasing miles and intensity, for example when approaching a marathon.
6 tips for managing ITBS and getting you back running
- First be sure this is what you have! ITBS involves pain on the outside of the knee. If you are not sure then it’s a good idea to get an assessment.
- Decrease your training load to a level at which the pain is manageable i.e. pain does not go above an intensity of 3 out of 10 during running or afterwards. For example, you might need to decrease the length of your runs or the intensity or frequency or some combination. In some cases, if pain is severe, it might be necessary to rest completely. Then you can gradually build back up again as symptoms improve.
- Introduce a hip strengthening program into your routine that includes exercises such as side leg raises, lateral band walks, glute bridges and hip hikes.
- You can use a foam roller or tennis ball to apply self-massage to loosen up structures that attach to the ITB and that help to maintain pelvic stability – basically work all around the hip and thigh, but be careful to avoid rolling on the area of pain.
- If you need some extra help, find a Massage Therapist who is experienced in treating ITBS and can assess your particular presentation and support you with specific rehab exercises. Clinical Massage techniques applied to hip muscles that tension the ITB and stabilise the hip can be effective in relieving symptoms.
- ITBS can also be improved with simple changes to your running gait. Slightly widening your steps if you have a narrow step width can ease strain on the ITB and improve symptoms (4).
References
- Beers, A. et al. (2008) Effects of Multi-modal Physiotherapy, Including Hip Abductor Strengthening in Patients with Iliotibial Band Friction Syndrome. Physiotherapy Cananda. Physiotherapie Canada, 60(2), pp.180-188.
- Fredericson, M. et al. (2000) Hip Abductor Weakness in Distance Runners with Iliotibial Band Syndrome. Clinical Journal of Sports Medicine, 10(August), pp.169-175.
- Fredericson, M. & Wolf, C. (2005) Iliotibial band syndrome in runners: Innovations in treatment. Sports Medicine, 35(5), pp.451-459.
- Meardon, S.A., Campbell, S. & Derrick, T.R. (2012) Step width alters iliotibial band strain during running. Sports Biomechanics, 11(4), pp.464-472.