Do you struggle with running at the same level you used to be able to do a couple of years ago? Do you have knee pain when you hit the pavement for your run? In this article we’re going to cover the 5 things you need to know about Iliotibial Band Syndrome!
If you are more of the visual and auditory learner just click the YouTube video below outlining everything that is in this article!
What is IT Band Syndrome?
This is the most common overuse injury in runners. The iliotibial band is actually connective tissue that connects to a muscle in your hip. This muscle is the Tensor Fascia Latae or simply referred to as the TFL. This is a small muscle on the outside front part of your hip. This connects to the iliotibial band which runs down the outside of your thigh and connects into the bone that crosses the knee joint. Where you really run into problems is where the ITB crosses the knee, that’s where we see most of the pain in our patients. So, the IT band is connective tissue, not an actual muscle, which is why it’s called a band. It’s fibrous connective tissue like the fascia in the body. The reason why it’s going to be really tough to stretch this structure is because it’s a tough connective tissue and the majority of it is this long band and then the small little muscle in the hip. Technically you can stretch the muscle in the hip, but the band itself you cannot.
Iliotibial band syndrome is more common in females. The rationale and reasoning behind this is because women have a larger pelvis! The wider pelvis puts women as a disadvantage when it comes to running!
How do I know if I have it?
There will be very localized pain to the outside part of the knee. The pain will be very specifically pinpointed to the outside part of the knee. Sometimes this pain can be confused with a meniscal tear. A meniscal tear is completely different from ITB syndrome. A meniscal tear occurs from a specific event or trauma and is normally associated with clicking or a catching feeling in the knee. Iliotibial Band Syndrome occurs overtime with what we call an insidious onset. Maybe one day you’re running and feel a little bit of pain and then the next run it’s worse and then it’s highly irritable and you can’t ignore it. That’s when we would start consider Iliotibial band syndrome.
A common question people have is do I need imaging such as an X-Ray or MRI to determine if I have ITB Syndrome? The answer is no! The history and onset is normally a clear give away and then a good physical exam by your running physical therapist will help to differentially diagnose and determine if you pain is in fact Iliotibial band syndrome. An x-ray will not show anything regarding this diagnosis as x-rays show bone imaging. An MRI would show the iliotibial band but it won’t show any damage to the tissue itself. Based on this, you want to see your physical therapist first instead of needing to go to an orthopedic physician who is a surgeon. In case you were not aware, you do not need a prescription first to go see your Physical Therapist, you can go directly to your PT for a diagnosis!
What causes it?
ITB syndrome is mainly a repetitive overuse injury. As your knee is bending back and forth during running you’re causing irritation to the tissue. Another sport that is common for this syndrome to occur is in cyclists and triathletes who are cycling and running performing many repetitions of repetitive knee bending. Another aspect that can cause this condition is if your leg rotates in. If you’re flat footed and you overpronate during running, your leg will rotate in and can cause more stress on the outside part of the knee. Something else we want to pay attention to is the surfaces that we’re running on. First of all, look at your sneakers. If you’re getting a lot of wear and tear on the outside of your sneakers, that may be a good indication that your foot is pronating and rolling in too much. If you’re running on a lot of country road and the road that you’re running on is banked, you’re always going to have one side that is higher than the other, and you’re leg is going to be rotating inwards. This can be a contributing factor and cause as to why you’re getting ITB syndrome. Another factor can be if you’re running on a track going only one way, you’ll get that same situation where one side is higher than the other! These are all contributing factors that may lead to Iliotibial band syndrome.
How do I get better?
So how do we treat Iliotibial band syndrome? First and foremost, you’re going to need to back off your mileage. We’re not saying shut down running. However, if you’re having current pain, you need to back off a little bit so that you can allow some healing to start. You need to think about switching up the surfaces! If you’re running on those banked surfaces, you need to think about running on some flat surfaces. If you’re doing a lot of mileage on a track, think about some safe roads that you can run on or switch it up on the track and run the other direction. It may look silly but it’s healthier for YOU! If shoe wear is the contributing factor, you should be counting your mileage. You should be switching your shoe wear every 300 to 400 miles. Track your miles so that you’re aware of how much you’re putting on your sneakers. Only wear your running sneakers for running so that you can track how much damage those shoes are taking primarily from running.
Next, you’ll want to foam roll your iliotibial band. However, Do NOT roll on the outside part of your knee where you have all of your pain. You won’t feel any better and you’ll just cause the pain to increase. You’ll want to roll the Tensor Fascia Latae muscle in the hip and then roll in front of the IT band and slightly behind the IT band. This will cause a decompressive effect to the actual band! Do not roll right on the side and go for the kill, it’s extremely painful and you won’t feel any better! Click this LINK to see my personal recipe on how to foam roll the TFL and ITB.
You’ll need to strengthen the glute muscles. Primarily, you’ll want to focus on the gluteus medius muscle which is your outside hip muscle. This muscle stabilizes your pelvis when you are running and you step on the leg. Every time you step on your leg, every time you’re running you are only stepping on one leg and the gluteus medius helps to stabilize here. We want strengthen this muscle primarily to prevent the leg from dropping in as that can be a contributing factor to the development of ITB Syndrome. This is by far one of the most important muscles runners need to focus on strengthening! Click this LINK to see my favorite gluteus medius isolation exercise for runners to wake this muslce up!
How do I prevent it?
This is actually the fifth tip in our five tips of healthy running! You have to train smart with proper progression! We don’t want to go out there and ramp up our mileage out of nowhere. You need to be smart about your training. You always want to think about your shoe miles. Take a look at your shoes BEFORE you get your pain. Are you tracking 500 miles? Go replace your shoes! That way you can prevent the condition before it happens. Next, we want to think about strengthening! Strengthening your hip muscles, quad muscles, your core muscles! Running is a repetitive activity and you want to be strong in all areas. You want to train smart so that as you progress as a runner, you will be able to run to your best ability!
Check out all 5 of my healthy running tips in this previously posted blog article by clicking THIS LINK
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Are you a runner that is trying to stay healthy but can’t train because pain is stopping you from meeting your goals?
Are you worried that an injury will limit you from doing what you love like working out and training?
Have you wondered what it will cost you in the long run if you continue to train through pain?
Have you seen other medical providers in the past that just tell you to stop your activity?
We have a unique treatment approach that focuses on solving these problems with our clients. We combine manual hands-on techniques with guided supervised exercises to help you get stronger, pain-free and perform at your peak level to get you back on the road doing what you love. Our goal is to help keep you active and on the road, while recovering from injury by guiding you in ways to modify your training, rather than eliminating running!
The SPARK Physical Therapy Commitment
No long waits or multiple trips to providers’ offices every week. We see you either onsite at a partnering gym or in the comfort of your home when it is convenient with your schedule.
One on one for a full hour with your doctor of physical therapy, every visit. We provide you with a customized plan specifically designed for you, based off your unique injury and goals.
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Thank you for taking the time to read,
– Duane Scotti, PT, DPT, PhD, OCS
A special thanks goes out to Allie Eldridge, SPT for her contributions to this article
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“I developed IT band syndrome during my first marathon training cycle last year and ended up in physical therapy for about 3 months. I was told not to run if I had any pain at all. I lost so much time “recovering” that I ended up deferring my registration to the next year. I spent the next summer training for the same marathon when about 6 weeks out, that familiar IT band pain returned. I could barely finish a mile. I didn’t want to go back to my physical therapist because I knew what he was going to tell me. Stop running. I was so frustrated and started to feel like marathons weren’t for me. I stumbled upon the healthy runner podcast and learned that I don’t have to stop running in order to recover from injury! I was skeptical about an online physical therapy session. But I reached out to Dr. Scotti and he was able to give me the tools to mitigate my pain within the first session! I was able to complete my training cycle and made it to the finish line of my first marathon with his help! I highly recommend!”
“I’d been dealing with Proximal Hamstring Tendinopathy (PHT) for about 4 years and had been doing PT, but still had lingering pains. I just figured I’d have to suck it up and deal with it because that was as good as I was going to get. But then, I came across a podcast of Duane being interviewed by Jason Fitzgerald on PHT and how he overcame the injury, and my curiosity was piqued. I met with him virtually and he has been a GODSEND! I’m able to sit as I type this! I can bend over and get in and out of cars without pain! And, I’m RUNNING again!!! It is amazing to be able to do things that I haven’t been able to do without pain since 2016!!! Thank you so much Duane for being an incredible PT!!”
“I suffered from IT band syndrome for four years before seeing Dr. Scotti in April 2020. Before then, I couldn’t run more than about 10 minutes without stabbing pain near my left knee. I’d seen various orthopedists, physical therapists, and chiropractors looking for some relief. My career needed me to run a mile and a half within a certain amount of time, and it was impossible to do so with the knee pain. I saw Dr. Scotti and he immediately got to work! That first visit, he helped me understand the anatomy and underlying cause of my knee pain (aka IT Band syndrome). Once I understood what was happening, the course of treatment made so much sense. Not only did he have online videos of all the recommended exercises to treat the problem, his “healthy runner” Facebook group, Podcast, and YouTube videos held a wealth of information and supplemented my plan. I soon understood that running wasn’t just a casual hobby – it’s a sport and one that deserves dedication and focus. Without his dedication to the sport and his community, I wouldn’t have realized this! Over the next few months, I had many ups and downs – victories and failures – and even some tears! Two steps forward and one step back. Dr. Scotti always checked in between appointments and tweaked my plan if needed. By August, I was regularly running 3-4 miles with barely any pain! If I did get pain, it was because my dedication and focus were lacking – and I quickly picked it back up and overcame. I’m so thankful I took another chance at having my knee looked at and trusted someone else. I run regularly now and am really enjoying it. I can’t thank Dr. Scotti enough and would highly recommend him to anyone having trouble.”
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