ITBS: Using Foam Rollers

author : AMSSM

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I've got ITBS and foot issues and have been rolling it out with the foam roller. How long should I roll per session and how many sessions per day?

Member Question

I've got ITBS and foot issues and have been rolling it out with the foam roller.  How long should I roll per session and how many sessions per day?  IT HURTS SO BAD!  How long will it take to get well and then if it gets well, how about rolling maintenance?  Thanks!

Answer by Dave Olson, MD and Robby Sikka, MD
Member AMSSM 

Iliotibial (IT) band syndrome is a common knee injury seen in triathletes and runners.  It may be caused by excessive friction of the distal IT band as it glides over the lateral femoral epicondyle during repetitive flexion and extension of the knee. Potential risk factors may include: preexisting iliotibial band tightness; high weekly mileage; time spent walking or running on a track; interval training; and muscular weakness of knee extensors, knee flexors, and hip abductors.¹

Most patients report diffuse pain over the lateral aspect of the knee, and they are often unable to indicate one specific area of tenderness initially.  Over time the pain often localizes to the lateral femoral epicondyle and/or the lateral tibial tubercle. Patients typically report pain after the completion of a run or several minutes into a run; however, as the IT band becomes increasingly irritated, the symptoms typically begin earlier in an exercise session and can even occur at rest. Symptoms are worsened as patients run down hills, lengthen stride, or sit for prolonged periods with knee flexion.³

Diagnosis

A physical exam may reveal tenderness on palpation of the lateral knee approximately just above the joint line.  Symptoms may be worsened when the patient is in a standing position and the knee is flexed to 30°.  Slight swelling may be noted at the distal IT band, and palpation may reveal multiple trigger points in the vastus lateralis, biceps femoris , and gluteus medius. This may cause referred pain to the lateral aspect of the affected knee. The Ober’s test may be used to assess tightness of the IT band and strength of the lower extremity should be assessed with particular emphasis on the knee extensors, knee flexors, and hip abductors.^1-3  Differential diagnosis may include pathology of both the hip and knee including biceps tendinopathy, degenerative arthritis of the hip and knee, lateral collateral ligament injury, lateral meniscal tear, myofascial pain, patellofemoral pain, referred back pain, and stress fracture. MRI may show a thickened IT band over the lateral femoral epicondyle, and often detects a fluid collection deep to the iliotibial band in the same region.⁴

Treatment of ITBS

Treatment of IT Band syndrome includes activity modification, massage, and stretching and strengthening of the affected limb.  Any activity that requires repeated knee flexion and extension should be limited. As the acute inflammation diminishes, the patient should begin a stretching regimen that focuses on the iliotibial band as well as the hip flexors and plantar flexors.  Once the patient can perform stretching without pain, a strengthening program focusing on the gluteus medius should be initiated.^1,5  

Use of foam rollers

Use of a foam roller may be helpful for triathletes and runners with IT band syndrome.  Use of the foam roller for 60-second intervals over the painful or tender areas 2-3 times per day can be helpful to relieve symptoms or prevent symptoms from occurring.  Rolling over bony areas should be avoided, and stretching should be a mainstay of treatment and prevention.

Resuming running

Running may be resumed only after all strength exercises are performed without pain. A return to running should be gradual, starting at an easy pace on a level surface. If the patient is able to tolerate this type of running without pain, mileage may be increased slowly. For the first week, patients should run only every other day, starting with easy sprints on a level surface. Most patients improve within three to six weeks if they are compliant with their stretching and activity limitations.⁵

Dave Olson, MD University of Minnesota and Robby Sikka, MD
TRIA Orthopaedic Center
8100 Northland Drive
Bloomington, MN 55431

1. Messier  SP, Edwards  DG, Martin  DF, Lowery  RB, Cannon  DW, James  MK, et al.  Etiology of iliotibial band friction syndrome in distance runners.  Med Sci Sports Exerc.  1995;27:951–60.
     
2. Fredericson  M, Cookingham  CL, Chaudhari  AM, Dowdell  BC, Oestreicher  N, Sahrmann  SA.  Hip abductor weakness in distance runners with iliotibial band syndrome.  Clin J Sport Med.  2000;10:169–75.
     
3. Orchard  JW, Fricker  PA, Abud  AT, Mason  BR.  Biomechanics of iliotibial band friction syndrome in runners.  Am J Sports Med.  1996;24:375–9.
     
4. Ekman  EF, Pope  T, Martin  DF, Curl  WW.  Magnetic resonance imaging of iliotibial band syndrome.  Am J Sports Med.  1994;22:851–4.
     
5. Panni  AS, Biedert  RM, Maffulli  N, Tartarone  M, Romanini  E.  Overuse injuries of the extensor mechanism in athletes.  Clin Sports Med.  2002;21:483–98.

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date: March 27, 2013