Do you get stubborn pain on the outside of your knee with running especially going up hills? This could be sharp at times and may even cause you to walk during your run. Have you thought… will IT band syndrome ever go away? Have you tried rest, ice, and stopping running but every time you try and go back that pain just comes back and stops you in your tracks?
In this blog article and Healthy Runner Podcast episode, SPARK Physical Therapy wanted to help you as a runner become stronger with specific strength training on how to fix iliotibial band syndrome (IT band syndrome). In this article, I will share with you the causes, symptoms, treatment, and prevention to help with iliotibial band syndrome in runners. Following these running tips and exercises will help build up your body to be more resilient with your running and prevent future injuries.
Click the video below to watch the LIVE training I did on this topic within the Healthy Runner Facebook Group
The iliotibial band (IT Band) is a thick band of connective tissue that runs from the outside of your hip down to just past your knee. When this tissue becomes inflamed or irritated, it can cause pain on the outside of your knee. Rarely can it become painful and irritated up near the muscular attachment at the hip area. IT band syndrome is considered an overuse type injury and there are some simple solutions that will fix this condition that does not require injections or surgery.
The symptoms of IT band syndrome that a runner may experience are usually associated with increased training loads with running whether you are a new runner, just starting back up from a long break, or starting a new training plan that increases your mileage, speed, or adds hill work into your training. When the IT band becomes aggravated or inflamed it will cause pin point specific pain that you can point to on the outside of your knee. This may be sharp at times that causes you to stop running and have to walk for some of your run. This sharp pain is usually most noticeable when the knee is bent at about 30 degrees either during the stance or swing phase of your running gait pattern. It is theorized that is when the IT band passes over the lateral femoral condyle (boney bump on your femur bone). The IT band may also be very tender to touch when you have this condition.
Excessive training can result in doing too much, too soon before your body has a chance to make the necessary adaptations to tolerate the demands of running. This results in excessive load and strain to the soft tissue (IT band) in this case. To learn more about how to properly train smart with proper progression Click This Previous Blog and Podcast Episode to prevent IT Band Syndrome from coming back on your next training cycle.
Some runners have a shorter and tighter IT Band length due to the repetitive nature of running. When this happens this band can pull more at it’s attachment point causes more rubbing over the outside of the knee. The only true way to determine if your IT band is short is to have it assessed by a medical professional with the Ober Test. This muscle is nearly impossible to see if you have a tight IT band on your own.
Weakness of your side hip muscles (gluteus medius and minimus) is the biggest contributing factor for IT band syndrome. Your primary hip abductor muscle is the gluteus medius and weakness in this muscle as well as your hip external rotators can change the mechanics of your running thereby putting excessive load and tension on the IT band.
For example, when these muscles are weak our hip tends to drop when looking from behind as well as the knee tends to dip in (valgus alignment).
One of the easiest ways to see if you have strong side hip muscles is to simply stand on one leg and lift your opposite knee up like if you were marching (Trendelenburg Test). As you will see in the image above, if you have strong side hip muscles then your pelvis will remain level or even go slightly higher. If you have weakness of your gluteus medius muscle then your pelvis will drop on the opposite side. This is the most common weakness I see in many of the injured runners I help. However, performing this standing test is simply not enough in the presence of mild weakness. That is why it is essential to have your running gait pattern examined by an expert who knows what they are looking for during a running analysis. Personally, I take slow motion videos of all the runners I work with and analyze their movement pattern. One of the compensations I look for is to see if their pelvis is remaining level in the midstance phase of their running. Due to the muscular demand being far greater with loading the leg while running, this usually is the best option to pick up on hip weakness as opposed to the standing Trendelenburg test. This is where I will find subtle weakness that could be the root cause of a runner’s IT band pain.
Roads that are not level and have a large camber to allow the water to drain are not the best for running especially long distances. If the angle of the road is large enough, this causes a temporary leg length discrepancy causing one leg to be functionally longer than the other because your foot is hitting the road first on the higher side. Overtime, this can cause your pelvis to be uneven and put more tension and strain on the IT band.
The treatment for IT band syndrome is going to depend on the level of tissue irritability. For simplicity, we will talk about high and low tissue irritability. An example of high tissue irritability would be if your pain just started a couple of days ago and your pain levels are 8/10 on a number rating scale and it not only hurts with running but also is painful with walking, getting up from a low chair, and going up and down stairs. This would be the only time I would recommend to take a couple of days off from running totally and the treatment may include strategies to decrease inflammation such as oral over the counter medication or applying ice to the tender spot on the knee.
Luckily for most runners the most common scenario is low tissue irritability in which this is more of a chronic issue that has built up over the course of a couple of weeks or even months (we are stubborn as runners and just think it will go away one day). This pain usually only occurs during your runs and only at specific times or right after a long or hard run. The most important thing to keep in mind if you fall into this category is to modify your activity but DO NOT STOP RUNNING. What? You may be thinking “did a physical therapist just tell me that I don’t have to stop running when I have an injury?”
The answer is yes because active rest, modifying your training, and building up your strength are keys to getting this common condition better and has worked for the hundreds of runners I have helped with this condition.
Here are some specific treatment remedies you can do on your own within the comfort of your home or while you are at the gym. However, this is no substitute for an individualized assessment by a medical provider who specializes in working with runners and helped many people suffering from IT band syndrome.
Before we get into what you can do…Listen to THIS VIDEO if you roll your IT Band and it is so painful! I have been there before and I share my story with a LIVE demo.
Foam rolling the muscle (TFL) and rolling just in front as well as just behind the IT band can be an effective way to decompress the tension on the band prior to your runs or allow for a nice post run foam roll session. This video below explains how to exactly foam roll the top 5 running muscles and you will see the TFL/ITB is the 4th one in this series. I hope they help you. Can I ask you for a favor? While you are viewing this video on my YouTube channel, if you found it helpful can you do me favor and SUBSCRIBE to my channel and hit the bell to be notified of the latest video that can help your running? This will greatly help these videos reach more runners like you who need solid running advice from a healthcare expert in the running field. Thank you in advance for your help in getting the word out to the running community. To learn more about Soft Tissue Care For Runners (foam rolling and stretching) click this previous blog article and podcast episode.
Here is my personal favorite to isolate and learn how to activate your side hip muscle. I call it the humbler because it looks easy but can humble you quickly no matter how strong you think your leg muscles are! The key is performing this exercise against a wall to avoid the common compensation of using your TFL muscle (contributes to more tightness) as opposed to the back fibers of your gluteus medius muscle. To learn more about STRENGTH TRAINING in order to run click this previous blog article and podcast episode.
In order to strengthen your hips for running and fix that hip drop weakness that is so common in runners, you need to train your muscle with your leg on the ground. To learn more about the importance of training on one leg and why they are the best exercises for you to perform as a runner, CLICK THIS previous blog and podcast episode. The 2 exercises below are a nice starter to learn how to activate this muscle in a standing position that will translate into your running.
The key to preventing IT band syndrome from starting or coming back is to perform some type of prehab program which includes foam rolling and dedicated exercises for your outside hip muscles. Here is one exercise I always include once a week in my training in order to prevent IT band syndrome or runners knee from coming back! Performing these will give you a nice burn in those hip muscles.
Do you want to know more about our SPARK Physical Therapy running injury clinic to help you with your knee pain or learn more about our healthy runner evaluation to get you on a specific plan to PREVENT any running related injuries so you can continue hitting the pavement doing what you love?
Thank you (running friends) for taking the time to read and I hope you enjoy the podcast episode!
Stay active, stay healthy, and just keep running!
Duane Scotti, PT, DPT, PhD, OCS
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