IT Band Syndrome

The iliotibial (IT) band is a thick strand of connective tissue that runs along the outside of your leg, from the gluteus maximus and tensor fasciae latae on the side of the hip down to the outside of the tibia/shin. Unfortunately, this band can cause problems for runners when it becomes impinged or rubs as the knee bends, creating friction. IT Band Syndrome, also known as ITBS, generally manifests as pain (sometimes extreme pain) at that impingement point where the band passes along the outside of the knee. It can often be mistaken for knee pain. While there’s some dispute over whether the IT band itself is actually touching bone or if it’s surrounding tissue that rubs against the bone at the knee flexion point, the end result is the repetitive motion of running, which causes irritation, inflammation, and pain. It sounds simple, but it’s one of the most commonly debilitating injuries for runners.

The iliotibial (IT) band is a thick strand of connective tissue that runs along the outside of your leg, from the gluteus maximus and tensor fasciae latae on the side of the hip down to the outside of the tibia/shin. Illustration: Oliver Baker

The iliotibial (IT) band is a thick strand of connective tissue that runs along the outside of your leg, from the gluteus maximus and tensor fasciae latae on the side of the hip down to the outside of the tibia/shin. Illustration: Oliver Baker

Symptoms of IT Band Syndrome

  • Pain is most frequently felt as a sharp point on the outside of the knee, or (rarely) as sharp pain on the lateral side of the hip.
  • Commonly, pain occurs after a certain amount running; not upon first step.
  • While pain generally goes away after ceasing activity, it often comes back when running is resumed.
  • It’s most common in new runners, or after an increase in mileage or hill running.

Causes of IT Band Syndrome

When bending the leg, a healthy and loose IT band slides easily past both the bone on the outside of the knee and the bone along the top of the hip ridge. But when things go wrong, an unhealthy IT band rubs against those bony spots. Various factors are believed to increase these problems: weak hip abductors, a tight IT band, tight hamstring and glute muscles pulling on the IT band. Even the way in which the foot strikes the ground can impact the IT band.

A number of studies have found that one of the leading causes of IT Band Syndrome is weakness in the hip and glute muscles, because it creates tugging on the IT band. It’s also common for mechanical issues, like over-supinating or over-pronating, to stress the IT band. And many runners find that as fatigue sets in, their ankles or knees collapse inwards, which in turn pulls on the IT band, forcing it to rub against that bony spot on your knee.

Treatment of IT Band Syndrome

First and foremost, stop doing things that cause pain or irritation. This frequently means modifying activity. It can mean not running for at least 1-2 weeks. During this period, you can also take inflammatories; however, decreasing acute inflammation will not resolve the underlying cause of the initial problem. Do not resume training until the acute pain has stopped.

Once the pain subsides, many runners find relief in soft tissue work such as massage, stretching or foam rolling. Stretching has been found to help make the IT band more pliable, which can resolve the issue. This one stretch is particularly effective. Lay on your back, pull your left knee up to your shoulder, push your knee over to your right shoulder with the palm of your left hand, hold for about 20 seconds, release and then repeat four or five times. Repeat for the other side.

Because IT band tightness and pain can stem from tightness in the hips, glutes, hamstrings, and even calves, it’s recommended to roll and stretch those areas as well. Foam rolling can be effective when runners first experience tightness, because it helps to prevent that tightness from turning into full-blown IT Band Syndrome. Begin to add strength exercises for glues and hips, but only after the pain has subsided.

Since running form flaws can contribute to IT Band Syndrome, some runners have success with an orthotic to relieve that pronation. In bad cases, it is also possible to develop an inflamed bursal sac around the knee, which may require a cortisone shot. If the IT band pain doesn’t resolve after many months, surgery should be a last resort and you should consult a doctor.

Preventing IT Band Syndrome

Strengthening the hips and glutes is the most valuable treatment strategy for IT band syndrome. These muscles will control rotation of the femur, position of the pelvis, and ensure the IT band is not compressed or “pulled away” from the hip. 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. Add these strengthening exercises into your training schedule about 2-3 times per week.

Increasing mileage, intensity or hill work too quickly can lead to ITBS.This is why many new runners or runners upping their mileage and hill efforts often have IT band injuries. Volume should increase no more than 5-10 percent per week and longer runs should be done at slower pace than shorter runs. Vary running surfaces as well. Mix hilly runs with flat routes. Try trails and soft surfaces to ease the pounding placed on legs by only running on roads.

Wear proper, supportive running shoes, changed at regular intervals. A running shoe loses about 50 percent of its shock absorptive capacity after around 300 miles. Keeping shoes for too long increases the risk of ITBFS and other injuries. Since overpronating or supinating as you land can stress the IT band, getting fitted for the right shoe is essential. A running specialty store can offer many shoe suggestions that will help running form.

Prehab is also essential to preventing IT band flare ups. Schedule regular massages or physical therapy sessions, even when healthy, to prevent any issues from occurring. Foam roll a few times per week to keep muscles from tightening up. A little prehab goes a long way to preventing most running injuries, and is less costly and time consuming to practice healthy than when injured.

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