How to Eliminate IT Band Pain

Ask Coach Jenny

Q: I’m struggling with ITB pain on the side of my knee.  Do you have any exercises that are helpful for this?  Thanks, Emily

A: I’m sorry to hear about your ITB issue Emily, but there are several exercises that can help. Before I get to them, let’s talk about what the ITB is and does…

The ITB (Iliotibial Band) tightness is a common running injury among all levels of runners. The ITB is a band of tissue that runs from the gluteus down to the outside of the lower leg just beneath the knee. Its main role is to extend the leg and stabilize the leg while you run.

It is important to mention that the key to healing is to identify what may be causing the condition to begin with. For instance, bumping up your mileage or intensity too much too soon is one of the greatest reasons for developing ITB. Also, changing to new shoes, running on a cambered road (slanted) and having weak core muscles and muscle imbalances can cause this pain. Part of your ITB recovery plan should include an inventory of your training and other variables to allow your body to heal without aggravating it and prevent it from happening again in the future.

In many cases, making changes to your regimen, weaving in cross-training with low impact activities (elliptical), and focusing on strength and flexibility can resolve the ITB issue. If it lingers for more than a few weeks, it is time to get a proper diagnosis from your doctor.

Here are three exercises to improve strength and mobility.

ITB Foam Roll – [Excerpt from Running For Mortals]

This exercise is similar to rolling out cookie dough or pie crust. Lie on your side and position the foam roll under your hip. Put the top foot and hands on the floor for stability. Use your arms to slowly roll your body over the foam from just below the hip to just above the knee. It’s a little like a “Search and Rescue” mission. When you find a knot, stop, hold and breathe. Try to stay on the knot for 15-20 seconds until it releases. Walk your way in reverse and repeat 10 times.

It may feel very uncomfortable at first and maybe even painful. If it is so painful you can’t lie on the spot, try to get as close to the spot and work into that area. Little by little, the foam roller will help release the knot as well as the pain. Perform this exercise before or after your run or workout.

Bridge with Ball – [Excerpt from Running For Mortals]

Lie on your back with your hands by your sides on the floor and a playground ball or rolled up towel or foam roll between your knees.

Using your gluteal muscles (buttocks), squeeze and lift your hips off the floor until you make a diagonal line from your knees to your hips and shoulders. Only the shoulders and feet are on the floor. While lifting, press the knees in toward the ball and contract your buttocks muscles, squeezing in an up and in motion. This will activate the gluteal and adductor (inner thigh) muscle groups. Pause for a few seconds and lower your hips back to the floor continuing to press in to the ball and repeat. Draw your naval into your spine and focus on two motions, pressing into the ball or towel and squeezing up toward the ceiling.

Progression:

When this gets easy, progress and make it more challenging by lowering to a few inches off the floor and repeat. Even harder – put your arms on your stomach while you perform the exercise, or try the exercise with one leg.

Single Leg Stance – Hip Huggers

The single leg balance activates and strengthens your stabilizing muscles from your feet and ankles all the way up to your hips and improves your balance, too! If you sit all day like most of us do, your gluteal muscles that stabilize as you run stride for stride are deactivated. When these muscles atrophy (decrease in strength and stability) they no longer engage and support your leg and hip as your foot lands on the ground and can cause friction inflammation in your knee and hip.

Stand up with your feet hip width apart. Keep your arms out to your sides for balance. Lift your left leg a few inches off the floor and hold for 30-60 seconds. Engage your hip muscles to create a long, neutral line up your body.

Let your hip on the planted leg side relax out to the side and then tighten and contract it to align it under your shoulders. Try this in front of a mirror and you’ll see your hip go out of alignment and as you contract the hip your body will realign as pictured above.

Repeat for 30-60 seconds on each side or until fatigued, approximately two to three sets. You will feel the muscles in your foot, ankle and hip fatiguing in seconds! This is a great exercise you can do anywhere – even in line at the grocery store!

When this is easy, progress to performing the exercise without wearing shoes.

When that gets easy, stand barefoot on a towel, pillow or pad to further challenge the muscles and balance.

By performing these three exercises daily, your ITB pain should diminish or disappear, as well as improve strength and mobility for future runs.

Do you have a question for Coach Jenny? Submit your question here.

Barefoot Running and Marathon Training

Ask Coach Jenny

Q: Is starting barefoot running training a bad idea when combined with marathon training with existing trainers?

A: It’s not that it’s a bad idea as much as it is an aggressive one. When training for a marathon, the training plan consistently builds in mileage, intensity and volume through the season.   Traditional marathon plans cut back every two to three weeks to allow the body and mind time to recover and adapt to the demands of the training progression. The balance of the building and cutback weeks balance the stress on the body and optimally prepare you to tackle 26.2 miles.

When you transition to barefoot running or minimalist shoes, it is very much like an entirely new sport in that it uses different muscles to move you forward. It also takes a considerable amount of time to build up the strength, flexibility and the skin’s resistance to running without shoes.

If you’re like most, your feet have been living the high life in your supportive shoes. That makes life convenient in that we don’t need to focus all that much on where we step nor do we need to have strength and mobility to walk or run. The shoes do much of the work for us.   Going from a supportive shoe environment to barefoot running is a significant change and challenge for your body. It requires the time and patience to build the strength, flexibility and sensory skills to move with less under foot. This can be easily demonstrated by taking the one-legged stance test.

Kick off your shoes and socks and stand on one foot for one minute. Unless you’ve been living barefoot, you’ll begin to feel muscles you never knew you had firing to stabilize your body. It’s not about weakness – it’s about our body adapting to its natural shoe habitat.

If I were coaching you, I’d encourage you to wear your go-to running shoes while marathoning and use the season to supplement with foot strengthening exercises that will help you make the transition post season. Here are three such exercises:

Single Leg Stance:

  • Stand up with your feet hip width apart.
  • Keep your arms out to your sides for balance.
  •  Lift your left leg a few inches off the floor and hold for 30-60 seconds.
  • Engage your hip muscles to create a long, neutral line up your body. If this is confusing – try letting your hip relax out to the side and then tighten and contract it to align it under your shoulders – this is also another great exercise called hip huggers.
  • Repeat two to four times on each side. You will feel all the muscles in your foot, ankle and hip fatiguing in seconds!
  • When this is easy, progress to performing barefoot. When that gets easy, stand barefoot on a towel, pillow or pad to further challenge the muscles and balance. If you get to SuperStar status, close your eyes (very hard).

Toe Lifts:

  • Stand barefoot with your feet shoulder width apart. Stand in a tall neutral position, toes facing forward and look down at your piggies (toes). Balance your weight across the ball of your foot and heel.
  • Lift all ten toes up and then slowly lower one toe at a time from pinky (the one that went “wee wee wee” all the way home) to big toe. If this is a challenge, sit and use your fingers to assist until you gain the dexterity.
  • Repeat 10-15 times per foot once and progress in time to two to three sets of 15.
  • When this gets easy, progress to lifting each toe up and then down one at a time.

Heel and Toe Raise:

  • Stand barefoot with your feet hip width apart and your weight evenly distributed over feet.
  • Raise up on your balls of your feet and hold for one to two seconds and lower.
  • Raise up your toes and hold for one to two seconds and lower.
  • Repeat heel and toe raises for 30 seconds.
  • Newbies begin with one set and as your feet grow stronger increase to two to three sets at 45-60 seconds.
  • When that becomes easy, brag about it to your family and friends and up the ante by performing this exercise on a stability pad, folded towel or pillow.

You can also build up your foot and lower leg strength along the way without going barefoot quite yet. For instance, once you’ve built up your foot strength and mobility with the exercises above, you can weave in the following activities to continue to transition towards running with less underfoot.

  • Walk around your house barefoot for short periods of time (five to 10 minutes) every other day. This builds your sensory skills as well as foot strength and is a great first step in going barefoot. As you gain strength, build on the amount of time by five to 10 minutes every two weeks and then do so daily. Let your body be your guide as everyone’s tolerance varies.
  • If you’re a gym person, use the elliptical machine with minimalist shoes or socks (if the gym allows). This will further improve your foot strength but without the impact of running.
  • Walk before you run – continue your journey to less by walking in short periods of time (one to two minutes) on a treadmill before or after your training runs.

Going barefoot doesn’t necessarily have to be all or nothing, and the truth is – a little goes a long way in improving your running form and strength and decreasing the risk for injuries. As you build into this slowly, you may find that supplementing barefoot exercises and drills to be the perfect complement to your running program. You may also want to experiment with more in running drills or workouts. The important thing is that you go especially slowly, avoid doing much of this during your marathon training, build and dedicate the time and effort it requires to make the change to running with less.

Do you have a question for Coach Jenny? Submit your question here.