Last week, Becky from Olives and Wine had some IT band issues, and blogged about how disappointing it was that her knee pain was interrupting her training for her first marathon. Like many first time marathoners, she wanted to find a way to push on in spite of her injury. Having suffered my own IT band issues early in my 50 state marathon quest, I could sympathize completely with what she was going through. It sucks to have your knee act up while you’re running! Fortunately, I had a few ideas for her to be able to keep going – and when a few others asked for more details, I decided it might be worth a blog post of its own.
Please note that while I have a RRCA coaching certification, I am not a doctor. I would strongly encourage you to discuss your training plans with your doctor for approval before continuing to run with an injury.
So first, some background. The iliotibial band (IT band or ITB) basically runs from your butt down to your knee, adjusting as the leg bends and straightens. It helps to stabilize the knee, which is why if it’s not working properly, you end up with knee pain. Inflammation of the IT band occurs a lot in distance runners, mostly because of overuse. Cambered roads can be especially problematic in causing IT band injuries, since one leg ends up being downhill of the other while you’re running, throwing off the body’s natural balance. Generally, IT band tightness is caused by weak hip and butt muscles; meanwhile, weak quads can contribute to Runner’s Knee (another common source of training injuries). You can guard against both of these by lifting weights diligently and keeping your muscles strong.
Pain, in general, is your body’s way of telling you that something is wrong – so it’s never wise to just ignore it. However, IT band issues can be as severe as sharp pain in the knee, or as mild as some slight tension and tightness. If what you’re experiencing is closer to the latter, I definitely understand the motivation to just run through it and not give up on your marathon dreams! If it’s the former, you may be able to heal it to just the latter by resting for a week or so and then starting this protocol from there – but I’d strongly encourage you to both see a doctor and also consider putting your marathon plans on hold for a season if the pain is really that severe.
The first step is getting through the tightness is make sure to start stretching out that pesky IT band – here’s a fantastic article on the best stretch for the IT band, as well as a whole lot of background on what the IT band is and does. You can learn a ton from that article!
Next, get ready to make your foam roller your best friend. Foam rolling is less effective when you do it all at once, so you’ll need to do it frequently if possible, though each session doesn’t need to be long. Consider rolling for five minutes in the morning when you wake up, another five minutes after any long periods of sitting (like right when you get home if you work at a desk job), another five minutes after any kind of workout, and one final session right before you go to bed.
To target the IT band, lie on your side on top of the foam roller, with the roller at your hip. (I find that’s less painful than starting with the roller at your knee.) Very slowly start to roll so the roller is moving down your leg toward your knee. Now here comes the crappy part: whenever you get pain from hitting a tight spot, stop rolling and hold that position until the pain subsides a bit. It’s going to hurt, I know, but that pressure is ultimately helping to relax the muscle. Make sure that you are supporting some of your weight on your hands while doing this, and move more weight from your leg into your hands to lessen the pressure as needed. You should feel uncomfortable, but not in severe pain! The more you do this, the looser that IT band will get – and eventually, it will loosen enough to where its able to do its job and protect/stabilize your knee. For more on foam rolling, check out this awesome DailyBurn article by Christine.
So… what about running? All the foam rolling in the world is not going to train you to run a marathon – it just loosens up the muscles and IT band so that you are able to train. However, your training protocol will be very different than usual if you experience IT band issues during your marathon training cycle.
If you’re having knee issues of any kind, the last thing you want to do is keep pounding away on a hard surface. You want to lessen the impact as much as you can, so you’re going to cut back on your running schedule to ideally only be running two days per week. And those days are going to be short runs of fewer than 6 miles, ideally on dirt/grass/another soft surface. You’ll probably have a natural inclination to make these runs fast, since the distance is short, but these should actually be at long run pace.
What about your long run, though? Running a marathon definitely requires a lot of endurance, and that gets built up over time. Even if you were already doing 20 milers before you developed the IT band issues, you’ll need to keep it up if your marathon is more than a few weeks away. So, move your long runs from pounding the pavement to circling the elliptical machine at the gym. To figure out how long to go, convert your long runs from miles to minutes at your old long run pace – so if you were a 10 minute miler and scheduled to run 18 miles, do three hours (180 minutes… ugh, I know) on the elliptical.
One critical thing to note: since the elliptical picks up momentum in a way that regular running doesn’t, you’ll need to be diligent about making sure your heart rate still hits workout levels. With long runs, you can usually relax and not worry too much about your pace, but when you’re doing a simulated long run on the elliptical, you’ll need to periodically check in and refocus to ensure that you’re working as hard as you would while running.
By combining the short actual runs with the simulated long runs on the elliptical, you’ll keep your muscles in “I know how to run” shape and also get your cardiovascular system up to the endurance challenge, but minimize pain/injury from running. This strategy is not going to get you to run the fastest marathon of your life; rather, it’s meant for those who simply must complete 26.2 miles even after they’ve been injured. If you’re choosing to run the marathon anyway, remember that you will likely be in pain during your marathon, and will be whenever you run long distances until you’ve actually resolved the source of the issue. (Please, take a break and do that!) However, if you are bound and determined to run no matter what, rest as much as possible the week before your goal race (switching even the short runs over to the elliptical), and minimize pain until you can’t put it off any longer (the actual race). Post-race, it’s back to that foam roller to loosen the IT band you’ve probably once again tightened.
Anyone else tried this approach, or any tips to add? From the comments on Becky’s post, there are a lot of people who’ve been saddled with this injury!