When you increase your running mileage, you put more strain on your muscles, tendons, and ligaments. Many runners do not have perfect running mechanics, and while a less-than-perfect stride may leave you just a little sore when you're running 15–20 miles per week, it can easily lead to injuries when you up your mileage to 30 or more miles per week.

What is ITBS?

One of the most common injuries among runners who have recently increased their mileage is iliotibial band syndrome, or ITBS. This syndrome is an inflammation of the tendon that runs from your hip to the outside of your knee. Runners who develop ITBS notice pain at the outside of the knee. Generally, this pain occurs over a wide surface rather than at a specific point.

 Early in the development of ITBS, runners may not notice symptoms until they are partially through the run, but as they continue to run through the pain, it becomes constant throughout the day. Moderate to severe cases can take months to heal and require physical therapy, ice, and stretching. ITBS can sideline you for an entire season, or keep you from even reaching the starting line of your marathon.

Strategies to Prevent ITBS

Before you increase your mileage, it's essential to have a plan in mind to prevent ITBS. The best approach is a comprehensive one, which includes

• Increasing mileage slowly: As you run more, your tendons and ligaments slowly adapt to the increased demand. Adding mileage too quickly puts too much strain on these tissues, and particularly on the IT band. Experts recommend increasing mileage by no more than 10% per week to avoid this and other injuries.
• Running on flat surfaces: When you run on the side of a banked road, one leg is forced to sit lower than the other in your pelvis. This puts excess strain on the outside leg, often leading to IT band syndrome.
• Performing exercises to strengthen the hip flexors: If your hip flexor muscles are weak, your hips may rotate to the inside as you run, placing excess strain on the IT band. Include some hip flexor exercises in your workouts two or three times per week to avoid this issue.
• Visiting your chiropractor: Especially if you have been running on the side of the road, your hips may not be sitting evenly in your pelvis. This can lead to IT band syndrome as you begin to increase your mileage. Visit your chiropractor for an adjustment to make sure everything is properly aligned before you increase your mileage. Regular adjustments every 2–4 weeks will keep your weight distribution even throughout your training.

Most overuse injuries, such as shin splints and runner's knee, occur in runners who are brand new to the sport. ITBS is different. Because it is caused by improper biomechanics that don't tend to affect the body until higher mileage is reached, it typically strikes more experienced runners. Don't let it take you down – follow the prevention tips above for a healthy, higher-mileage training season.