In this video, we're going to look at how can you decide whether you should stop running or whether
it's OK to continue running if you've got IT band syndrome. We'll also look at running style factors
that may contribute to you developing IT band syndrome. And then lastly, we'll also look at how
you can adapt it and why a slow return to running with a run-walk programme can be so useful.
For those of you who don't know me, my name is Maryke. I'm one of the physiotherapists from
sports-injury-physio.com, where you can get online physiotherapy assessment as well as treatment for
your injuries. Have a look at the description of this video if you want a link to our website.
How can you decide whether it's okay to continue running while you do your rehab
or actually, you're making your injury worse and it would be better if you stop running? So,
the two things we want to look at are: How does it feel while you run? When does your pain come on?
How intense does it feel? And also, what is the 24-hour response to that run? So, how do you feel
the next day and with your normal activities the next day? So, let me explain this in more detail.
If you go for your run, and you feel that the pain only starts later on in the run and it doesn't
really feel that painful, it only goes up by a 1 to 3 out of 10 discomfort, and then, when you
stop running, that extra discomfort you felt while you were running calms down within an hour or two.
And you wake up the next morning and actually, all your activities feel exactly the same as
it felt before the run, it doesn't feel more sensitive, you don't end up with a achy knee, then
actually it may be okay to continue running. Now, I will still say,
it's best if you can adapt your runs then, that you keep it to the distance you can do without
pain. So, if the pain really starts to increase at around three or four kilometres, I would
say limit it to three, four kilometres. But the interesting thing about IT band syndrome is also,
it often tolerates short, intense sessions much better than long, slow runs, so … And the reason
for this is when you do a short, high intensity session, usually you have better form, and
actually the impact through the legs can be less because you have quicker cadence when you do it.
So often, my patients with IT band syndrome find that they can do repeats up hills or up stairs,
but they just can't run down, or they can't go for a slow jog, because that really kills their knee.
So, play around with it, because it may be that actually you can keep some of your running fitness
if you do stair … flights of stairs that you run or things like that, short intensity sessions,
but make sure you still check, how does how does it feel while you're doing it – and
you're not running down by the ways, just up – and how does it respond in the 24 hours after?
Now, it may be better if you stop running and first focus on rehab if you find that your pain
starts to increase really soon into your run, it gets quite painful while you're running, and
it lingers for quite long, so, you'll find that the rest of the day,
your knee is really uncomfortable, and the next day it’s not quite as good as it used to be.
It may even be that actually you didn't feel that much pain while you were running, but the next day
it really isn't happy with you. If any of those things apply to you, it may be useful to actually
just stop running and focus on rehab. I will also say that most of the research studies out there
that look at treatment for IT band syndrome, they usually get their participants to stop running and
doing their sports for the first six weeks, and just strength train and stretch and do all the
things that's been found to be useful. Now, I've made videos about strength training and stretching
if you want more advice about that as well, and I'll link to it in the description of this video.
So, if you're in doubt and you're not quite sure and you don't seem to make any progress really
with your rehab and the IT band is not improving, I would say just stop running for six weeks
and focus on your rehab, focus on getting strength, focus on getting it better, and then
reintroduce your running again. There are a few things in your running style that may contribute
to your IT band taking more strain than what it should. Now, I will say that, in my experience,
most of the time it's overtraining and people ramping up their mileage or doing a marathon
when they're not really fit enough for it that irritates the IT band; it's not usually
their running style. But if you've gone back to running and you've done your strength training,
you've done … You've really looked after your loads, and it's just not improving,
then playing around with your running style may make a difference for you. So, the three things
that can be significant are: One, if you run and your pelvis drops quite a lot while you're
running. Because, as the pelvis drops, it can pull the IT band tighter over the side of the leg,
which can then cause increased compression at the knee. Now, that usually goes hand in hand
also with, if your knee turns in more than what it should. So remember, it's normal for the pelvis
to drop a bit, normal for the knee to turn in a little bit, but it's if it's excessive, then that
can also cause the IT band to pull tighter. And then lastly, if you're … If you run with quite a
narrow gait, so, we call it ‘tightrope running’, that literally … And often you'll find that you
kick yourself by the ankle, so you'll see a lot of mud by the ankles, that's a sign that perhaps
your legs are swinging quite narrowly forwards and you're placing your feet quite narrow.
That can actually increase the strain in the IT band as well. Now, how do you change this?
So, one of the most effective ways that they found in the research to decrease impact forces on the
legs is by increasing cadence. Now, it doesn't help to increase your cadence if you already
have a really fast cadence. So, if your cadence is between 170 and 180, I wouldn't mess with cadence;
that sounds quite good to me. But if you find that your cadence is quite slow, so
160, 165, or below 160, then increasing your cadence may help. Now what's cadence? Cadence is,
simply put, the number of steps you take in a minute. So it's how quickly you move your legs.
Now, why is that significant? The slower we step, the longer time we spend on the floor,
the more the impact through the leg, the more time it has to turn in, pelvis to drop,
and everything like that. And they've shown, if you increase your cadence by just 5%, it can
make a significant difference. But of course, it depends on how slow your cadence is to start with.
So, it will make a bigger difference for the guys who's got slower cadence.
A good method to figure this out is, first of all, what is your cadence? Your watch will likely tell
you that. Or if you don't have a smart watch, then you can just count how many steps you take
in a minute. So, time yourself how many steps you take in a minute. Then, download a metronome app
that gives you pop, pop, pop, pop, that you can set for a timer, and work out what is a
5% increase on your cadence, that you want to try and change to. And then, when you go out running,
listen to it and try to keep up with it. Now, it will feel exhausting, because it's not your normal
way of running, so it's going to take more energy at the beginning,
and that's why it's good to do run-walks, but I'll get onto that in a minute. So, expect it
to be tiring at the beginning, and you will not be able to keep it up for a full run. You'll have to
do it short stints to allow your body to grow stronger and yourself to get used to it. Now,
the second thing that can be useful is, often, if people over-stride, it again causes their pelvis
to drop more or ... higher forces through the legs basically, which can increase the pelvic drop,
the turn, the crossover. Now, what is over-stride? It's if you put your leg ... hits the ground with
your heel quite far ahead of your body. Heel strike is absolutely fine; that's not a problem;
lots of people run with heel strike. It's only if you do it really far out in front of your body.
And the reason for that is, it acts as a brake. So, if you put your foot down right in front,
quite far ahead of you, it acts as a brake before you come through, so, there's a bigger
impact on that leg. So, by bringing the leg more underneath you and trying to land more
underneath you, you can actually decrease the impact forces again. And then the last thing is,
if you run with quite a narrow gait, like a crossover gait, and you find that actually
you do kick yourself, then it may be worth, when you feel that happening, to just think, ‘Just
bring my legs apart a little bit.’ Now, you're not going to run as if you're doing a squat;
it's a tiny bit that you've got to improve it on. And what I find for myself - because I love,
when I'm tired especially, to just sink into my runs and then I get injured - is, when I feel that
happening, that I just think about improving my form: How much are my legs turning in?
Just decrease it a tiny bit, that I don't let it just flop the way that it wants to do.
And all of these things will be new things for you; it’s not your normal way that you run.
So, you can't just expect to go out and do it. And this is why a run-walk can be useful. One, it
allows you to, during that one minute that you're running, it allows you to really focus on form,
get a feel for your body, and work the muscles in you the way that you want them to work in.
But then, you may find by the end of that minute, you're quite tired. So, you need that walk period
of one to two minutes to just recover and get it all back, and then you can do another minute
where you really concentrate and do that. And that's one of the best ways to really get back
into it and make sure that you keep good form. The second is, whenever you've had an injury like IT
band syndrome or any other injury, that area has lost some of its strength. Now, you would have or
should have rebuilt the strength to a degree through doing strength training exercises,
but they are always lower impact than running. So, easing into a run with a run-walk programme
also means that you're strengthening that tissue but never get to the point where you're exhausted
fully, because before you’re really tired, you start to walk. So, it's one of the best ways to
avoid re-injury when you go back to running. So, let me know if you've got any questions.
And if you need more help with an injury, you're welcome to consult one of the team via video call;
the link to the website is in the description of this video. Take care!