I ran a marathon some years ago and during the race I developed severe pain on the outside of the knee which hurt when I moved but not when weight-bearing. I have been told this is a I-T band problem. It seems to only happen when I run on roads but not on trails. What should I look for in a shoe, and what exercises can I do to prevent it? Wwould a knee brace help?

IT band syndrome (aka, ITBS) is a common problem in marathon training. I'm not a medical professional but I had it pretty bad several years ago so I'll offer some suggestions. The docs at Clearwater helped me get through it and they are a great resource for treating ITBS. Lots of things can be done to avoid it, and other things can be done to treat it once it happens.

As for shoe choices, I'm not sure what to tell you there but people experienced at fitting runners in shoes can be of some help. For me the important thing was using an insole that I bought at Portland Running.

For me an important factor causing my ITBS was a leg-length difference -- once that was spotted Dr. Bryan gave me a 6mm lift that was very beneficial.

Stretching is a good way to head off ITBS before it flares up. Most stretches are easier to describe in pictures than words so best if you can find some on the web with photos. I did a quick google search and found a few ITB stretches at http://www.runningtimes.com/rt/articles/?id=6099

Another aid is to use a foam roller to stretch the tensor fascia lata (or TFL), the long, skinny tissue that connects from the ITB to the hip. Some stores sell a small device called "the Stick" which can be used for this as well. The idea is to stretch out the TFL somewhat so it doesn't rub over the bones on the outside of the knee where you feel that pain.

As for the knee brace, my personal preference is to avoid stuff like that but I have worn one for related conditions when advised by my physician. I don't think I would just try that on my own, though.

Dear sekdvm,

In addition to Coach Eric’s reply I’ve added some more information from the clinical side. Since the problem shows on roads only I would start with shoes first by talking to the crew at Portland Running and Walking Company on Saturday, they are very current on models and correct fit for your foot style. Also, keep in mind the life of running and walking shoes is about 6 months or 300-500 miles. Even when the tread is still good the internal support changes within that time and may not be adequate for you. The best prevention is 5-8 minutes of stretching/movement prior to running and after 10 to 15 minutes of stretching for tone balancing and elongation of warmed up muscle tissue. Bob Anderson's book "Stretching" (ISBN 0-394-73874-8) is a great resource for routines with pictures, on pages 128 & 129 is a 15 minute group that I recommend for runners and walkers minus stretch #'s 1, 14 & 16, those stretches will hurt the knees. Also on the preventative side, squats and short lunges are helpful to condition the same muscles needed for running. If these exercises are painful or too difficult this indicates problems down the road before they show. I am also with Eric on the brace, it is best to try and understand the cause of conditions before removing the display, unless it’s race day! Please stop by the tents on Saturday and Dr. Jake or I can quickly check your squat and lunge stability to see if that is also a factor. I hope you have a great season.

Cheers,

Dr. Bryan