The Ultimate Middle Age Runner’s Guide to IT Band Syndrome

Iliotibial band syndrome (ITBS) is the one of the most common running injuries [1]. It is the main cause of lateral knee pain in runners.  In this article, I will discuss signs & symptoms of IT band syndrome. Additionally I will review how best to diagnose, treat & cure ITBS.  Lastly and most important, I will review strategies to strengthen and prevent ITBS from recurring or occurring in the first place.

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I’m not a trained medical professional, so please use the contents of this post as guidance. As a certified coach, I have used a network of medical professionals as resources for my injuries to whom I refer my local clients. If you’re experiencing any kind of pain that forces you to change your gait, then you should stop running and seek professional medical attention to properly diagnose, treat and prevent recurrence of your injury.

​The iliotibial band (IT band) is a thick band of fibers that runs from the pelvis and down the outside part of the thigh until it attaches into the tibia (shinbone). The gluteal or buttock muscle fibers and the tensor fascia latae (muscles of the hip joint) attach to it. The IT band serves to coordinate muscle function and stabilize the knee during running.

Iliotibial band syndrome (ITBS) shows itself as pain caused by inflammation of the band as it crosses the lateral femoral epicondyle (this gives attachment to the one of the ligaments of the knee-joint. A bursa or sac in this area allows the IT band to glide over the end of the femur.  If you’re suffering from this injury your IT band usually gets sore after a set distance into a run. 

It’s common that you may not initially feel pain for the first few miles, but eventually the outside of your knee will start to ache and ultimately the pain progresses from a dull stiffness to a sharp or burning pain in your knee.

If your IT band is too tight, bending your knee creates friction. This leads to swelling of your IT band and bursa, which results in the pain of IT band syndrome.

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Unfortunately, if these symptoms are ignored, further inflammation and scarring may occur in the bursa, causing progressive knee pain. Most runners report that their pain is worse when going down hills.  They also feel pain when sitting with their legs bent for a long time.

Root Causes and Risk Factors IT Band Syndrome

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Inflammation of the IT band most often occurs because of overuse. It’s very common with long-distance runners, especially athletes training for longer races. 

Root cause is typically one or more factors:

• Bio mechanical issues such poor flexibility and weak quads, glute & hip muscles (discussed below). Weak hamstrings are another contributor. Other less common mechanical issues (such as leg length discrepancy) can cause the injury. 
• Training errors such as running on one side of the road only where there’s slight slant will cause one leg to always be downhill from the other.
• Excessive pronation
• Hip abductor and external rotator muscle weakness . In a healthy and strong runner, these muscle groups keep the hip abducted (moving inward towards midline) and the knee externally rotated, which limits the strain on the IT band. Unfortunately, when these muscles are weak, the hip adducts (moves away from midline and the knee internally rotates after impact with the ground. This results in pressure on the IT band and the underlying sensitive tissue as discussed above. Since the hip muscles control the mechanics of your knee, if you have weak hip abductor muscles and poor hip rotator muscle strength, your knee will be at a higher risk of injury.

Diagnosis – When to See a Doctor

If you’re experiencing any of the above symptoms and the pain is causing you to change your gait, I strongly recommend getting with a medical professional to discuss your pain. A physical examination is often necessary to confirm ITBS.  Typically they will look for general tenderness over the site of the iliotibial band at the knee joint, and they’ll seek tender points where the bursa is located.

Oftentimes the medical professional will complete additional examination so they can see if some weakness or imbalance in the hips, glutes, quads and/or hamstrings is root cause. 

This imbalance or weakness is the most common root cause. 

Also, because many athletes complain that their IT band is tight, a qualified health care provider will having the patient complete a variety of stretches and not only confirm tightness, but also recommend appropriate stretches.  

IMPORTANT: DON’T STRETCH THE IT BAND 

It’s not a “stretchy” tissue. 

Research suggests that you should target the muscles that attach to the IT band: the gluteus maximus and the TFL.

Pain should be a signal to a runner that a problem exists and often signals an overuse situation. Rest, ice, and appropriate use of over-the-counter antiinflammatory medications) may be adequate therapy to return to your previous activity level. However, keep in mind that pain can be a signal that some kind of bio-mechanical problem exists, and left untreated it may lead to future injuries.

If this conservative home treatment fails to completely resolve IT band pain or if the symptoms worsen, or if the symptoms occur with decreasing amounts of activity, it’s time to be seen by a health care professional for further evaluation and treatment.

Medications & Treatment Options for IT Band Syndrome

Initially the goal with a diagnosis of IT Band Syndrome is to control & minimize the pain. This can be accomplished with anti-inflammatory meds such as ibuprofen.  Also, ice can be applied to reduce inflammation.

Since IT Band Syndrome typically occurs with runners, the medical professional treating the injury may recommend that the athlete stop running for a short time. Acceptable exercise alternatives during treatment are usually non-impact activities such as swimming, elliptical, rowing and biking.  I recommend discussing what’s acceptable with your treating health care professional, because each case varies.

Physical therapy is a common treatment option for many patients. To ensure the most appropriate treatment, the PT will often assess the patient’s running gait and style.  Their goal is to identify any underlying bio-mechanical causes of the IT band inflammation. In addition to the gait analysis, my PT also completed a flexibility and muscle strength assessment.

• Although the root cause of IT Band Syndrome is typically from weak hip & glute muscles in addition to weak hamstrings, I’ve interviewed a couple of PTs who suggested that depending on the runner’s gait, changing to a more stable running shoe or an orthotic insert did help correct any imbalances or abnormalities.

In my experience and in discussing with my PT, rest, ice, and physical therapy should be able to resolve the injury. However, if pain continues to persist, the health care provider may consider a corticosteroid injection into the inflamed area. This can be painful, therefore it’s typically a last resort. 

Foam Rolling 

Use a foam roller to loosen up soft tissue around the IT band, however, avoid rolling over the painful area.

The Best IT Band Exercises

For Preventing, Correcting & Managing Your Injury

CLAMSHELL with band – Lie on one side.  Prop your head in your hand. Bend knees at 90 degree angle. Use fitness band below your knees. While keeping the feet together, lift the keen on the top leg. Make the small movement shown in the photo (lift the knee until you feel a contraction in your glute. Repeat 10-12 times and then switch sides. 

Bridge – Lie on your back on the floor. Bend your knees & keep your feet flat on the floor as shown. Lift the hips us as high as you can until you contract your glutes. Keep squeezing your glutes as you slowly lower your hips to the ground. 

For additional challenge, lift up & straighten one leg while pointing your toe.  Another variation is with a resistance band around your legs, just above your knees.

Lateral Band Walk – Put a resistance band around your legs as shown below. Bend your knees slightly and facing forward, take small steps to one side while squeezing your glutes and hip muscles. Repeat the same movement, but in the opposite direction. While performing this exercise ensure you keep your chest and head upright and facing forward.  Go about 25 – 30 feet in each direction. 

Single Leg Squat – With legs slightly further apart than shoulder width, face forward. Lift one leg up and point toe forward while slowly squatting with the other leg (to prevent falling backwards, keep a stool behind you and keep squatting until just above the stool). Keep check & head upright.  Outstretch arms to improve balance. Do not let the knees move forward of your toes. Repeat the squats 6-8 times initially and then increase as you get stronger. Repeat on the other leg. 

Planks – Very effective for maintaining upright running form and strengthening your core. This helps to make you a more efficient runner, which can takes the pressure off your knee. If you’ve never done planks, starting by holding position shown in photo for 30 seconds.  Gradually increase hold in 15 second increments to 1:30.