When I started running in Physical Therapy School I did a lot of things wrong. Even with some guidance I still had a lot to learn. One of those things was how and when to do track workouts.
Just an FYI for anyone curious, DON’T do 3 track type workouts 3 days in a row going the same direction on the track. Not surprisingly I ended up with knee pain on the outside of my knee. Turns out, it was IT band syndrome. Since I know a lot of runners suffer from this particular pain, today is all about how to fix IT band syndrome in runners!
My goal for this post is general advice from my education and experience. Remember’ that it doesn’t substitute an evaluation from a Doctor of Physical Therapy for a more personalized assessment and treatment plan. However, these things can help relieve your pain if don’t consistently or even help prevent IT band syndrome!
What is IT Band Syndrome?
ITBS or IT band syndrome is a common overuse injury seen in runners and cyclists. It is typically brought on by a change in load or terrain during training. A significant increase in mileage, downhill running, track running, or going from road to trail.
IT band syndrome typically presents as a sharp pain on the outside of the knee. It is typically felt after a certain point during the run in the early stages, say after a couple of miles. IT band syndrome will appear pretty quickly/suddenly. Runners will usually report having tried pushing through the pain but with no luck and having an increase in pain as the run progresses. The sharp pain is typically described as tightness that increases with continued running.
Anatomically speaking, the IT band (which stands for Iliotibial band), is a thick band of fascia that starts at the iliac crest of your pelvis that runs down the outside of your leg before crossing the knee and ending on the top of the tibia. This is the place of pain for most people. The fascia rubs on the bone when simply put, it gets tight and causes inflammation and pain.
What Causes ITBS?
As I said above ITBS is an overuse injury caused by a significant increase in training load or terrain. However, it goes deeper than that. Some common causes of IT band pain are:
- Weak hips/glutes
- Decreased mobility in the hips (tight)
- Poor movement mechanics
- Poor running form
- Running too much, too fast, too far
As a side note, ITBS doesn’t typically go away by itself. This is something that you will need to work on to help it progress and get better. Also, once you have it if you don’t manage with the tips that I’m giving you it will more than likely come back. Management is key!!
Why Rolling Your IT Band Out Does NOT Work
Foam rolling does not work on your IT band. The IT band is super thick and just plain huge. The fascial tissue in the IT band requires 1000s of pounds of force to “change” it at all. This is why foam rolling doesn’t work. It might feel better for a little bit because we are getting a mechanical effect on the nerves and muscles around the area. The process is mechanical gating which distracts our BRAINS into thinking that it feels better however this is a short-lived response.
If you want to foam roll to help reduce the tension and perception of pain in the area, then start at the quad or the hamstring instead of directly on the IT Band which is typically more painful. Because we aren’t going to be actually breaking up anything directly on the IT band then it doesn’t need to be rolled on directly. This can just plain hurt. Get rid of the no pain no gain mentality!!
Think of it this way. ITBS is a friction syndrome and foam rolling is friction. Why would you add friction on top of friction?
How to assess IT Band Syndrome in Runners
Remember, as I said before this is general advice and not to diagnose. If you try these techniques and there is no improvement you should get checked out by a Physical Therapist and get a full evaluation to see what is going on!
We are going to start at the bottom for assessment. Most of the time knee pain, especially IT band pain is caused by either the feet or more commonly the hips. First, can your toes separate like your fingers? The muscles of the toes connect down to the foot which will help all the way up the chain and into the knee.
Let’s stand on one leg next. Are you straight and up tall? Does your hip pop out? What about your knee? Does it collapse toward the middle? This is a great assessment of how your leg is moving and supporting yourself.
How to Fix IT Band Syndrome in Runners
Should you stop all activity and REST?
NO. Your family doctor will typically err on this recommendation but that is not the best thing for us. Sure, after a week or two of resting it might feel better. However, as soon as we go back to running or doing activity the pain will come back, oftentimes worse than it was before. If you can’t run without less than 5/10 pain then walk. If you can’t walk then swim. Modify until you can find something that you can do that is not painful.
Also, make sure you are doing a good Dynamic Warm-up before your run to make sure your body is ready for the activity.
How to fix IT band syndrome in runners
First, know this, since the IT band is a thick fascia and not a muscle, you can’t relax it or stretch it out or lengthen it. However, you can stretch the muscles surrounding it. Further, this is a structure that gives stability and not something we want to “stretch and loosen up”.
Let’s start with the basics. Your first homework is to work on the two things I mentioned above.
- spreading your toes apart like you can your fingers
- standing on one leg while keeping your hips level working up to 1 minute.
Do the single leg standing in front of a mirror to check your form. These two things will make a huge difference on your daily life and how well you are supported and move for your running.
Have you had IT band syndrome? How did you learn to fix your IT band syndrome?
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