Playing the Pain Game: Dealing With Injury

Injury #3: The Dreaded ITB

The letters I, T and B repeated in order to any longtime runner is like an evil hex. The ITB, an abbreviation for the iliotibial band, is a strand of muscle and tendon that runs from the outside of the hip to the outside of the knee. With running, the tensor fascia lata, the muscle on the outside of the hip that becomes the ITB, tends to lose flexibility. The result is that the TFL and ITB can begin to pinch on the outside of the hip and knee.

Runners who are developing "ITB Syndrome" will describe a pinching pain, usually on the outside of the knee, which hurts during a run. Most people feel this pain one or two miles into the run, and the symptoms are often described as "someone is jabbing a needle into the outside of my knee."

Like many injuries, ITB problems are more easily treated the earlier they are diagnosed. The initial treatment often includes a good stretching regimen, the use of a foam roller on which the athlete lays and rolls on the upper leg like a rolling pin, hip-muscle strengthening exercises and sometimes orthotics or motion-control shoes.

Occasionally, a corticosteroid injection into the area of pain can fix the problem. Most importantly, much like stress fractures, trying to run through an increasingly painful ITB can cause a much more prolonged recovery. With the ITB, the earlier we see it, the quicker the fix.

The symptoms: Sharp, stabbing pain during a run, usually in the outer knee.

The remedy: Again, early diagnosis helps. Use a foam roller three times a week to stretch the muscle, do hip abductor and adductor strengthening at the gym, possibly get an orthotic or corticosteroid injection.

Injury #4: Achilles Tendonitis

The Achilles tendon is so named because the Greek god Achilles was dipped into the River Styx by his heel, making his body invincible everywhere except there. He died when an arrow pierced his Achilles. Runners should take heed of his story, as the Achilles tendon is a vulnerable area on anyone's body.

Running injuries to the Achilles range from tendonitis and inflammation of the tendon to a partial tear of the tendon, worsening pain and a lump. As is the case with most injuries, a little careful attention can make a significant difference. The general cause of Achilles tendonitis is insufficient strength and flexibility in the muscles attached to it, the gastrocnemius and the soleus. When these muscles are tight, the tendon is under increased stress and can become irritated and, over time, can tear.

The best way to stretch the Achilles and the attaching muscles is to put the foot against a step with the heel on the ground and slowly lean forward, feeling the stretch at the top of the calf. Repeat with a bent knee, feeling the stretch lower down toward the heel. Ideally, this stretch is done daily, before and after exercise. Orthotics also can help correct the anatomic alignment. With Achilles pain, the key is to get it checked out early and avoid the chronic tear.

The symptoms: Achilles tendon injuries are potentially career-threatening. Watch for pain and, especially, a swollen bump on the tendon.

The remedy: Regular stretching, proper foot mechanics and the correction of factors that have caused injury in the past. A doctor may use an MRI to look at cases of severe pain.


Dr. Jordan D. Metzl is a nationally recognized sports medicine specialist at Hospital for Special Surgery in New York City. In addition to his sports medicine practice, Metzl is a 25-time marathon runner and three-time Ironman finisher.

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