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Some running injuries go under the radar a little bit! They’re not common enough to receive lots of research attention but they’re still out there and keeping runners on the sideline.
One such injury is Proximal Iliotibial Band Syndrome (Proximal ITBS). We had some questions about this on Running Repairs Online so I wanted to cover it for you and provide some ideas for treatment.
Proximal ITBS presents with symptoms around the iliac crest. Here’s a quick summary of the pathology and pain:
Reference: Decker and Hunt (2019)
Proximal ITBS can be confused with Gluteal Tendinopathy. There is certainly some overlap; they’re both more common in female athletes and aggravated by loading into hip adduction.
The key difference is pain location will tend to be higher with Proximal ITBS and usually more focal. Runners will often point to the iliac crest region as the site of their pain and it will usually be tender on palpation.
Symptom location varies in Gluteal Tendinopathy and there are multiple potential pain sites:
Fortunately, the management of Proximal ITBS is similar to Gluteal Tendinopathy in runners:
Load management – modify or reduce activities that aggravate symptoms. Often these include stretching and sustained hip adduction as well as running (especially on hills). The aim is to reduce aggravation to help symptoms settle
Restore strength – there isn’t a lot of evidence to guide us but clinically we often see hip abduction weakness in these cases, sometimes combined with reduced strength in the hamstrings or calf. Progressive strength work in non-provocative positions can address this and restore capacity
Graded return – once symptoms have settled a graded return to running and sport is required. Start at a manageable level and gradually build towards the patient’s goals to reduce risk of flare up
Shockwave? There is some anecdotal evidence for proximal ITBS – Benoy Mathew who specialises in hip, groin and running injuries has mentioned that focused shockwave may be helpful.
We might expect a slightly older demographic in Gluteal Tendinopathy and hormonal changes linked to the menopause are thought to play a key role in this and other sites of tendon pain.
A recent review suggested that nearly half of recreational female runners are of menopausal age. When I read this I realised I’d underestimated just how many of the runners I see in clinic are affected by this important stage in life. It’s a topic anyone who treats runners should know about.
For more on ITBS including assessment, differential diagnosis and treatment see our free video series.
