Gary was looking forward to his morning run. It was a cool yet calm morning, perfect for his 2-mile jaunt around the park near his house. He set out and within about a minute had a good stride going. He made it to the park and started around the trail, but then something changed.
It was only a twinge at first, so he tried to ignore it. However, with every heel strike, it got worse — a pain on the outside of his knee. He tried adjusting his stride a bit and shaking out the knee, but when he returned to regular running, the pain returned too.
Gary knew that “running through the pain” wasn’t a good idea, but he hated to give up his morning jog. He knew he wouldn’t feel as good throughout the rest of the day if he stopped, so he kept going, hoping the pain would subside as he warmed up more. Unfortunately, that didn’t happen and, before finishing his 2-mile circle, he had to slow to a walk.
Gary was frustrated. What was causing this now? Was it something he could heal quickly?
Iliotibial Band Syndrome — also called IT Band Syndrome, ITBS or “runner’s knee” — is an overuse injury that commonly develops in runners, bicyclists and other athletes. It affects the iliotibial Band, which is a long Band of tissue (sometimes called a tendon or ligament) that runs down the outside of the thigh from the pelvis to the tibia (shinbone), crossing the hip and knee joints. This Band is considered to be one of the hip abductor muscles and also helps with knee flexion and extension.
When a person is running, the IT Band helps stabilize the knee and hip, allowing the hip and gluteus maximus muscles to support the extension of the knee. When the knee flexes, this Band moves over the bony ridge on the outside of the thigh bone, then moves again when the knee extends. This repeated movement, which is common in long-distance and frequent runners, can result in the Band becoming inflamed or irritated.
IT Band syndrome usually comes on gradually, getting worse over time until the runner or athlete has a hard time continuing on in the activity. Symptoms include pain on the outside of the knee, usually right around where the bony part is. It tends to begin sometime during the run or other athletic activity, then gradually gets worse until the runner has to stop.
The injury can be misleading because usually after stopping running, the pain goes away. The runner may think all is well and start up again, only to find after a few minutes that the pain has returned. In fact, IT Band syndrome is frustrating, in general, as even after a few days of rest and possibly ice treatment, everything might feel fine, but then the injury may return as soon as the runner starts working out again.
Other Symptoms may include the following:
- Pain during running on the outside of the knee
- Pain that gets worse with running, particularly when running downhill
- Pain that feels worse when the heel strikes the ground
- Pain when bending and straightening the knee
- Pain when pressing on the side of the knee
- A tight feeling in the Band that runs down the outside of the thigh
- Difficulty moving the leg out sideways — a feeling of weakness
- Possible trigger points of pain in the gluteal muscles or buttocks
- Swelling over the painful area
What Causes Iliotibial Band Syndrome?
IT Band syndrome or runner’s knee is usually an overuse injury caused by repeated friction between the IT Band and the thigh bone at the knee. It’s a common injury for those who run regularly, but there are some factors that can increase risk:
- Tight “tensor fascia latae” muscle, a small muscle that sits just in front of the hip joint and connects to the IT band
- Tight or wide IT Band
- Weak hip muscles
- Overpronation or other problems in foot mechanics — pronation causes the foot to roll inward, which pulls the knee inward and increases the likelihood of friction between the IT Band and the outside of the knee
- Leg length differences
- Running on hills or uneven surfaces
- Other muscle imbalances involving the low back, pelvis, hips, and knees
- Abnormal tilt to the pelvis
- Bowed legs or bowed knees
- “Toe-in” position while bicycling
- Excessive squatting
- Sudden increase in activity
- Long periods of time spent sitting in a lotus posture in yoga
- Pushing too hard during workouts
Runners can also be more vulnerable to this issue if they regularly run on only one side of the road. Most roads are designed to be higher in the middle than on the edges to promote water runoff. Running on one side all the time means that one leg is always downhill from the other, which requires the pelvis to tilt slightly and can increase the risk of friction between the IT Band and the knee.
In addition, studies have shown that women with a more pronounced rotation of the hip while running seems to be at an increased risk of IT Band Syndrome while men with internal ankle rotation were also more at risk.
What Happens If You Don’t Treat Iliotibial Band Syndrome Correctly?
Like many overuse injuries, if IT Band syndrome is not treated correctly, it’s like to become chronic. In fact, it’s very common for IT band syndrome to be a stubborn injury that plagues runners and other active people repeatedly. It may seem to go away with rest but then returns again with activity.
Scientists aren’t sure yet why the injury keeps coming back, but we do know that an abnormal gait, poor running mechanics, muscle imbalances and more can increase the likelihood that the injury will return. Failing to address it properly can lead to long-term pain and reduced ability to participate in the athletic activities you enjoy.
Standard Treatment for Iliotibial Band Syndrome
The standard treatment for IT Band Syndrome includes the RICE protocol (Rest, Ice, Compression, and Elevation) to help reduce inflammation and pain. Over-the-counter anti-inflammatory medications may be helpful too. Stretching and massaging the area where it hurts can also help relieve pain.
If these methods don’t work and the pain returns, doctors usually prescribe physical therapy, which focuses on flexibility and stretching to relieve pain, decrease inflammation and retrain the various muscles around the IT Band. Other techniques that may help include ultrasound and “iontophoresis,” where electricity is used to help decrease irritation around the knee.
Most of the time, it’s muscle imbalances and/or poor form that are the underlying cause of the problem. Doctors can help evaluate a patient’s gait, pelvic tilt, bicycling position, hip strength and more to determine what may be putting excess strain on the IT Band, then prescribe specific exercises and perhaps shoe orthotics to help patients run and cycle more easily.
Exercises and Stretches to Help Iliotibial Band Syndrome
Although it’s always best to work with your doctor and physical therapist to determine what exercises and stretches may be best for you, below are some that are commonly recommended to help treat and prevent IT Band syndrome.
- Standing cross stretch: Place the leg you want to stretch behind the other one in a cross-legged position. While keeping both feet flat on the floor, push your hips out to the side you’re stretching until you feel a stretch in the outside of the thigh. Hold for 20 to 30 seconds and repeat.
- Partner stretch: This one requires someone’s help. Lie on your back and have a partner lift the non-stretching leg out of the way. Then, pull the leg you want to stretch across underneath it, keeping the knee straight until you feel a deep stretch in the outside of the hip.
- Tensor fascia latae stretch: Sit on the floor with one leg out straight. Bend the leg to be stretched at the knee and place the foot on the outside of the other knee. Using your hands, pull the bent knee toward you and across the straight leg until you feel the stretch on the outside of the hip.
- Glute stretch: Lie on your back with one leg flat on the floor. Pull the other knee up to your chest, then gently lay it down across your body until you feel the stretch in the outer hip and buttock. Hold for 20to 30 seconds and repeat.
- Clam Exercise: Lie on your side with the knees bent and together and the feet in line with your spine. Keeping the feet glued together, lift the top knee as far up as you can. Keep the back still and the bottom hip on the floor. Hold for 20 seconds, lower and repeat. Work up to doing more sets.
- Hip abduction: Place a resistance Band around the ankle and attach the ends to a heavy object or place an oval resistance Band around both ankles. Then, pull one leg out to the side, keeping the knee straight. Slowly let it down, then repeat. Increase your reps gradually. You can also shuffle slowly to the side while wearing the oval Band around both ankles and keeping the knees straight.
- Side leg raise: Lie on your side and lift the top leg to 45 degrees and then lower back down slowly. Repeat 20 to 30 times.
- Side hip bridge: Lie on your side and prop your feet up about 1 to 2 feet off the ground. Then, by pushing through your bottom foot, lift your torso using your hip muscles. Keep the back straight. Return slowly to the ground. Repeat 20 to 30 times.
To prevent IT Band syndrome from bothering you in the first place, follow these tips:
- Always warm up and cool down around your workouts
- Alternate which side of the road you run on or which way you run on the track
- Make sure you’re wearing supportive shoes
- Run with a shorter stride
- Regularly perform exercises and stretches that work your IT Band, hip muscles, thigh muscles, buttocks and hamstrings
- Cross-train — do other activities in addition to your favorite
- If you feel pain, stop immediately and rest
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Noehren, B., Schmitz, A., Hempel, R., Westlake, C., & Black, W. (2014). Assessment of Strength, Flexibility, and Running Mechanics in Men With Iliotibial Band Syndrome. Journal of Orthopaedic & Sports Physical Therapy, 44(3), 217-222. doi:10.2519/jospt.2014.4991
Phinyomark, A., Osis, S., Hettinga, B. A., Leigh, R., & Ferber, R. (2015). Gender differences in gait kinematics in runners with iliotibial band syndrome. Scandinavian Journal of Medicine & Science in Sports, 25(6), 744-753. doi:10.1111/sms.12394
Physical Medicine and Rehabilitation for Iliotibial Band Syndrome: Background, Pathophysiology, Epidemiology. (2018, April 6). Retrieved from https://emedicine.medscape.com/article/307850-overview?pa=XK5L0ORgFrE3UtQn8fr3a3rWQgS%2Bp4Y4TnE1Q%2B6ebYN0SXYZyce0sKi2qdLuL5UTVrJxKJt4DRD8mxYr6kYfOw%3D%3D