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Treating and Avoiding a Common Condition in Runners

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As running season quickly approaches, a number of runners may find themselves feeling pain in one of their hips following frequent training or exercise regimens. The pain is often caused by a common injury in runners called iliotibial band syndrome. Usually referred to as the IT band, the iliotibial band is a thickening of tissue on the outside of the thigh, extending from the outside of the pelvis, over the hip and knee, and inserting just below the knee.

The injury comes on very suddenly and after a run. Many will often feel a sharp pain and may not be able to straighten their leg all the way. The individual will also experience significant weakness and soreness in the entire leg, mainly centering in and around the hip, including the hamstring, glutes, and IT band. As with many running injuries, it is often hard to pinpoint what causes the pain and so it is important that diagnosis and treatment are sought immediately.

IT band syndrome is one of the leading causes of lateral knee, thigh and hip pain in runners and most orthopedists will recommend that the patient immediately begin a course of rest, anti-inflammatory medication and physical therapy. If the pain does not subside, an imaging study is prescribed, usually an MRI, to further investigate what is causing the pain and the best course of action, explained Dr. Ron Adler, Chief, Division of Ultrasound, Department of Radiology and Imaging, Hospital for Special Surgery.

If the runner is suffering from IT band syndrome, a skillfully acquired MR examination will reveal an abnormality to the IT band as well as along the side of the hip where there is a fluid-filled sac called the trochanteric bursa, that acts as a cushion between the tendons and bones,", said Dr. Adler. A similar sac can occur in runners along the side of the knee, near the attachment site of the IT band.

The orthopedic surgeon, in consultation with the radiologist, will determine the treatment plan based on the results of the imaging study. Dr. Adler noted that one of the newest and most effective treatment options is an ultrasound-guided cortisone injection along the IT band and into the trochanteric bursa to help reduce pain or along the side of the knee.

Ultrasound-guided injections using dedicated high-resolution ultrasound equipment are very precise and allow a radiologist to target the injections directly into the areas of abnormality, thus maximizing the therapeutic outcome of the injections.

"Also, direct real-time ultrasound during the procedure allows me to visualize adjacent neurovascular structures and minimizes the risk of complications," Dr. Adler continued. The guided injection plays a very important role in recovery and will allow the runner to continue a physical therapy regimen.

Often times, runners will be back up and on their feet in about a week following the injection, but it is important to note that all patients and their outcomes will differ.

Some key things that cause IT band syndrome include:

  • Running on a banked surface (such as the shoulder of a road or an indoor track) bends the downhill leg slightly inward and causes extreme stretching of the band against the thigh bone or femur
  • Inadequate warm-up or cool-down
  • Increasing distance too quickly or excessive downhill running
  • In cycling, having the feet "toed-in" to an excessive angle
  • Running up and down stairs

It is important that runners always warm up before a run, monitor aches and pains and consult with a sports medicine specialist when experiencing pain before, during or after a run.