Advice For Triathlete Dionne On Persistent ITBS?

See my more recent thoughts, on ITBS, at this link!

Hi folks,

Sites of ITBS and PFPS pain. The correct diagnosis of such conditions is critical.

Sites of ITBS and PFPS pain. The correct diagnosis of such conditions is critical. From: SaveYourself.Ca

A friend of mine, Dionne, is continuing to suffer real problems with symptoms of ileo-tibial band syndrome (ITBS). I know that endurance sports come with these kinds of problems and that we have to learn to work through them somehow. Having undergone two knee surgeries, and a bunch of physiotherapy, for generally self-induced training injuries I feel for my friend as ITBS really sucks. My eldest son, Nick, complained of similar knee problems, which prevented him from running, after he became seriously involved with kite boarding, that comes with it’s own biomechanical challenges I am sure. Nick has almost fixed this problem using rollers. Early in my triathlon training as a beginner I also suffered from mild ITBS, but it was soon corrected by a good sports masseuse, and what I called ‘her elbow from hellbow.’ A while ago I wrote a blog post about my one serious encounter with ITBS, and how it went away, melting like butter on a hot summer’s day. I was going easy in the marathon at the Lake Placid Ironman because I had psyched myself out at the tail-end of the bike leg. I was running too slowly or cautiously, and not as I had trained to run. As soon as I realized this around the 14-mile mark, I picked up my normal pace and that ITBS was gone within a mile. This tells me that modification of one’s running mechanics may be one road to a cure.

There is plenty of advice out there for this condition, and here is some that I like the sound of from Dr. Pribut:

“Self treatment for Iliotibial Band Syndrome:

  • Temporary decrease or stopping training
  • Side Stretching
  • Strengthen your hip abductors (gluteal muscles especially the gluteus medius ). This is critical.
  • Gentle foam rolling (not too hard a roller and not too painful)
  • Avoid crowned surfaces or too much running around a track
  • Shorten your stride
  • Wear motion control shoes to limit pronation or if you have been wearing motion control shoes, try less controlling shoes.
  • Carefully examine your training regimen (if you’ve been keeping a running diary – check it for possible training errors).

See: Dr. Pribut’s Tips for ITBS 

Side Stretch

The side stretching is performed while standing as follows: Place the injured leg behind the good one. If the left side is the sore side, cross your left leg behind your right one. Then lean away from the injured side towards your right side. There should be a table or chair that you can hold onto for balance on that side. This stretch is the best of several that exist for this area. Be careful not to overstretch. Hold for 7 to 10 seconds and repeat on each side 7 to 10 times. The side stretch stretches the lateral hip capsule, the tensor fascia lata, iliotibial band, and the latissimus dorsi. You’ll feel it on your side above your waist in addition to your hip.

Most importantly, Dr. Prubit provides a differential diagnostic list, or a list of other problems that might be mistaken for ITBS. It is clearly essential to get the right diagnosis if you want to apply the correct therapy.

“Differential Diagnosis of Lateral Knee Pain and ITBS

  • Lateral meniscal tear
  • Lateral collateral ligament sprain
  • Biceps femoris tendinopathy
  • Patellofemoral pain syndrome
  • Lateral patellar compression syndrome
  • Popliteal tendinopathy
  • Stress reaction or stress fracture
  • Proximal tibial-fibular joint sprain
  • Referred pain from lumbar spine
  • Referred pain from peroneal nerve injury

Dionne has a sprinters background not endurance running. So I wonder if she is using a running technique that is triggering her painful ITBS. My race experience would support this as a potential area of investigation.

All advice and input for Dionne would be very much appreciated.

-k @FitOldDog

Today’s workouts:


Workout PLAN Coach: Chris Hauth
Duration: 01:05:00
aerobic run
Distance: 3100.0 yd
Duration: 01:00:00
3100 Warm-up (500) 500 Choice Set #1 (800) – on :20 rest Two times through: 200 pull b.p. 3, 5 by 50 200 kick Set #2 (500) 10 x 50 on the fastest send-off interval you can maintain with only about :05 rest Set #3 (500) 5 x 100 (25 R, 25 L, 25 choice drill, 25 build) on :20 rest Set #4 (500) 10 x 50 trying to do the same send-off interval as the first 10×50 Set #5 (300) 300 easy – swim or pull – with perfect technique (long smooth strokes).


  1. In my opinion ITBS is the worst running injury shy of a broken leg. It will sideline you for months and even years if not treated with the utmost of care.

    My situation has some context too it though that must be understood before you take my advice:

    – My hips in general are tighter than average
    – I tend to hold tension in my body so everything including the ITB are tighter on me than on other folks

    When I came down with ITBS it was at a time that I was running 10 miles on Saturday mornings then kiteboarding for 2 – 3 hours in the afternoon. I promptly removed the running but the ITBS did not go away. I spent many years (~10) chasing my tail on this and finally got it solved. The solution for me is trigger point therapy on my quads and ITB every single day of the week.

    It seems like the injury is always there and waiting to re-inflame. With the trigger point therapy though it is manageable. Now I can do some very intense leg workouts in the gym. I have regained 100% confidence in my left leg now when performing lifts and kiteboarding!! Basically my legs feel like they did when I was in my early twenties thanks to the trigger point work.

    Good luck with your ITBS Dionne. I am glad to help with any tips etc. My case was possibly extreme so don’t let my story scare you 🙂

  2. missironman - Dionne Liles says

    It is so funny that you would write about this today. I started my blog about the same subject around lunch time. You have saved me a lot of details. In fact I think you will find that I have done everything except sit down completely. =) which I am considering doing for 2 weeks. My 28 week training period starts on April 11, and I want to go in as healthy as I can.
    Nick – I have heard a great deal of AWESOME things about you from your brother and father!!! Thank you for taking the time to share and respond to your father’s blog regarding my i.t.b.s. NIGHTMARE.
    Now Kevin And Nick: I need suggestions for getting control of this beast.
    I read no cycling. Right now I am cycling about 75 to 90 miles a week. Would you suggest I stop or reduce?
    Any suggestions about weight training?

    KEVIN: can you show me the technique for running in the pool?
    I am posting my treatment methods under DAY 27 on Since I already started typing it 😉

    • Hi Dionne, the trick is to develop techniques that do not inflame your ITB, be it on the bike or the run. This comes down to biomechanics that can always be improved with a little work (which is why I study Feldenkrais and Continuum). If you have no negative effects on the bike, you can probably do as much as you like. However, I suspect that if you have too heavy a bike load it will affect your ITB when you run. See you in the pool or the track. -kevin

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Disclaimer: As a veterinarian, I do not provide medical advice for human animals. If you undertake or modify an exercise program, consult your medical advisors before doing so. Undertaking activities pursued by the author does not mean that he endorses your undertaking such activities, which is clearly your decision and responsibility. Be careful and sensible, please.