In which I turn to the evidence to ponder why my IT band hurts, whether all the Pop Pilates videos I’ve been doing are helping, and whether I should start lifting. I mostly used running-physio.com as a sort of review of review articles in order to find links.
IT Band Syndrome
I thought there was good evidence that runners with iliotibial band syndrome (ITBS) had weaker hip abduction, meaning that they had weaker muscles of the sort that help you lift up your top leg when you’re lying on your side. I now think this is unlikely. Some studies on ITBS and strength:
- “Hip Abductor Weakness in Distance Runners with Iliotibial Band Syndrome”, Fredericson et. al. 2000. This study is the most widely cited. It compares a group of 24 club and collegiate distance runners with IT Band Syndrome to 30 distance runners from the Stanford cross-country and track teams. The injured runners had slightly weaker hip abductors than super-elite Stanford athletes on their non-injured legs and had significantly weaker hip abductors on their injured legs. All of the injured runners (no real control group!) spent six weeks rehabilitating their injuries. They strengthened their hip abducion, stretched, took anti-inflammatories, and stopped running. After six weeks, their hips were stronger and 22 of 24 were pain free. I think it’s obvious why this study is not convincing evidence for “weak hip abductors cause ITBS and strengthening hip abductors fixes it.”
- “Hip Abductor Weakness is not the Cause for Iliotibial Band Syndrome,” Grau et. al., 2008. I can only access the abstract, but it basically says that runners with ITBS don’t have weaker hip abduction.
- “Prospective study of the biomechanical factors associated with iliotibial band syndrome,” Noehren et. al. 2006. This one doesn’t have to do with strength, but its methodological soundness is so unusual that I included it anyway. Runners with ITBS seem to run slightly differently, but it’s hard to tell whether this is the cause of or a symptom of their IT band problems. So Noehren et. al. found 400 healthy runners, took data on their running mechanics, and watched to see which ones developed ITBS. The eighteen who developed ITBS did have different running mechanics, even while they were healthy.
- I had ITBS a few summers ago and spent about two months doing hip abduction exercises regularly. This didn’t seem to help. I developed ITBS again recently when I had been doing a much higher ratio of strength training to running than I usually do, including some hip abduction exercises. I know n=1 doesn’t count for much, but there is a meme that fixing weak hip abductors fixes ITBS and this worked for 22 of 24 in Fredericson et. al., so my experience leads me to doubt that claim.
In “Prevention of running injuries,” Fields et. al. identify two innate anatomical factors that contribute to running injury, cavus feet and leg length inequality, and also review “strength, biomechanics, stretching, warm-up, nutrition, psychological factors, and shoes.” They write that “Many factors influence running injuries, but strong evidence for prevention only exists for training modification by reducing weekly mileage.” In general, “I’m going to fix my injury by strengthening my X” doesn’t seem to work, or, more charitably, we don’t know which exercises will help yet. This includes core strength exercises.
In “The Impact of Resistance Training on Distance Running Performance”, Alan Jung reviews the effect of resistance training (moving heavy objects) on the general biological factors that are known to improve running performance. These factors are VO2 max, which is “the highest rate at which the body can consume and utilize oxygen” and is a general measure of ability to do endurance exercise; lactate threshold, “the point at which blood lactate accumulates above resting values”; and running economy, which is a measure of efficiency describing how much oxygen is needed to run at a given speed.
Looking at the studies in Jung’s review, resistance training seems to improve VO2 max only in sedentary people, although I would guess that anything would improve VO2 max in sedentary people. There are few studies on lactate threshold. The three studies that measured running economy, however, found big gains of 4%, 8.1%, and 22% in efficiency. In “Explosive-strength training improves 5-km running time by improving running economy and muscle power”, Paavolainen et. al. study a treatment group of ten elite male runners and a control group of eight elite male runners. For nine weeks, he treatment group replaced 32% of their training with “explosive-type strength training”, and the control group replaced 3%. These exercises included sprints and various jumping exercises. The treatment groups’ 5k times decreased by about 40 seconds, and this is statistically significant, while the control participants’ 5k times increased slightly (it was the off season).
The other study that measured running economy is “Strength Training in Female Distance Runners: Impact on Running Economy.”, by Johnston et. al. Over ten weeks, six female distance runners who had been running 20 to 30 miles a week and had not engaged in regular weight training for at least three months participated in “traditional strength training” in addition to their usual running, while a similar control group continued doing what they had been. They did these free weight exercises: parallel squat, seated press, hammer curl, weighted sit-up, lunge, bent-leg heel raise, and bench press.
Both of the studies on running economy look legit to me, but it’s not possible to say which exercises are the most helpful.
I expected to have more suggestions, but the research is pretty thin. If you want to get faster, do some squats and plyometrics, I guess. If you don’t want to get hurt, run less.