Many runners are familiar with the sharp pain associated with IT band syndrome.
When Michael Fredericson, the team physician for Stanford athletics and director of the school’s PM&R sports medicine service, first started working with the Stanford track team in 1992, top runners were regularly debilitated by IT band syndrome. Sometimes the pain on the outside of the knee would take them out of training for weeks, sometimes for the entire season.
Fredericson thought, “OK, this has to stop,” so he started doing research and developing protocols to treat the injury — which are now widely used to prevent IT band problems and to rehab back to running.
“It seems like such a simple thing,” said Fredericson. But of course, it isn’t.
In fact, when you first feel tightness and pain along the outside of your knee after a few miles of running, it’s common to think the problem can simply be stretched or rested away. But those suffering from IT band syndrome will find that the pain worsens if they continue until they’re no longer able to run. They will then find that they experience pain every time around the same point in the run — whether it’s 10 minutes or 30 minutes.
“It’s really shocking to them because it’s not like any strain they had before,” said Razib Khaund, a clinical assistant professor of medicine at Brown University.
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The problem comes with how the IT band works when we run. The iliotibial (IT) band is a thick band that extends from the tensor fascia lata (TFL) muscle and lateral glute muscles, along the outside of your leg and knee, and connects into the shin bone. As it runs across the outside of the knee, it gets impinged on that bone at about 30 degrees of knee flexion. Repeating that over and over as you run causes irritation.
Khaund notes that although there is some dispute about if the IT band actually rubs on bone, the end result is the same: your IT band gets irritated and inflamed. Once that happens — which most often manifests as pain on the outside of the knee — it’s time to move to the treatment phase of IT band syndrome.
First, you should modify activity, said Fredericson, depending on what causes irritation. For example, some people can run but not on hills (hill running is known to cause problems.) Cross-training can be good until the pain settles down, but cyclists frequently struggle with IT band problems too from the repetitive motion of pedaling. Anti-inflammatories can also help calm the injury down a little, he said. “Until you get out of that inflammation phase, it’s hard to do anything else,” said Fredericson.
After the pain decreases, it’s time to focus on soft tissue work, like deep tissue massage, stretching, and using a foam roller, said Fredericson. Deep tissue massage can be particularly effective at removing adhesions that build up between the quad and IT band. Many people also like to use foam rollers at home on the outside of the leg, hips, and hamstrings. Doing this when tightness first strikes can help prevent that tightness from turning into full-blown IT band syndrome — though some athletes overdo it with the foam roller.
The protocol Fredericson developed has athletes begin a strengthening program after recovering from the acute phase of the injury and after beginning the soft tissue work.
“A big mistake a lot of people make is that they start the strengthening right away,” said Fredericson.
Multiple studies have found that one of the leading causes of IT band syndrome is weakness in the hip and glute muscles, which then causes pulling on the IT band. Fredericson recommends exercises like leg lifts while lying on your side, single-leg step downs, bridges, squats, and the ever-classic clamshells. These can help not just rehab but prevent problems in the first place.
It’s also common for mechanical issues to contribute to IT band stress. Over-pronating or supinating as you land can stress the IT band. When fatigue sets in many runners tend to collapse their ankles or knees inward, which pulls on the band running along the outside of the leg.
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This is why many new runners or runners upping their mileage and hill efforts often have IT band injuries. After dealing with your IT band syndrome, ease back into running every other day and with short runs. IT band syndrome is unique in that it doesn’t typically hurt when running fast, likely because the leg doesn’t spend as much time in the dangerous impingement zone when sprinting. That means that as you come back from an injury, you can start with short fast intervals and slowly add volume.
It seems like everyone has IT band syndrome or just regular IT band tightness these days, but it may really be that we finally understand what was previously thought to be simple knee pain.
“It’s kind of like concussions and what we’re going through with concussions now. It’s been an epidemic forever, but we’re just diagnosing it now,” said Khaund.
About The Author:
Kelly Dunleavy O’Mara is a journalist/reporter and former professional triathlete. She lives in the San Francisco Bay Area and writes for a number of magazines, newspapers, and websites. You can read more about her at www.sunnyrunning.com.