What Is IT Band Syndrome & What Can You Do About It?

Runners often experience knee pain, and one of the main causes is iliotibial band syndrome (ITBS). The iliotibial band is a fibrous strap that runs from the top of the pelvis to just below the knee on the outer thigh. It helps provide stability to the upper leg and hips and works in concert with the hip muscles during outward movement of the thigh. It also helps prevent torsional or twisting movements around the joint of the knee.

What Causes ITBS?

Overuse, such as everyday training and running races and marathons, can cause stress on the ITB. When this happens, a runner may feel pain on the outer knee just above the point at which the ITB crosses over the knee joint. You may also hear and feel clicking sensations in the knee. This happens when the ITB snaps across the knee joint.

When walking or running, you may feel pain when your heel contacts the ground. The pain will worsen as you continue to walk or run. This is especially true if you are running downhill or running at a slow, steady pace, such as in a marathon.

Although stress and overuse do cause tightness in the ITB, the tightness is not really the cause of the pain. Instead, weakness in the muscles supporting and surrounding the ITB is the real cause. For example, runners may have very strong legs but rather weak core muscles and hip muscles. This imbalance can actually lead to pain in the knee caused by stress on the ITB. Specifically, weakness in the gluteus medius and gluteus minimus can be a major source of stress on the ITB.

What Can You Do About ITBS?

There are several treatments you can use when suffering from iliotibial band syndrome. Most can be used in combination without causing any harm or side effects.

Here are the three best treatments for ITBS:

1. Address the Inflammation and Pain

When you first begin experiencing knee pain, you should begin with the classic treatment:

Rest
Ice
Compression
Elevation

… also known as RICE.

Additionally, you may wish to use over-the-counter, nonsteroidal anti-inflammatory drugs (NSAIDs).

Muscle rubs containing capsaicin can be helpful if used consistently.

In severe cases, your doctor may recommend a corticosteroid injection for immediate relief.

2. Stretch and Massage the ITB

This band of tissue is extremely tough, so gentle massage by hand may not be especially effective. If you're lucky enough to have the services of a professional masseuse, a deep tissue massage can help a great deal with the pain and can promote healing.

Although many videos and articles recommend massaging lengthwise from the knee to the hip, you’re really better off massaging deeply from side-to-side across the ITB. Work your way up the ITB gradually in this manner, from knee to hip. This helps break up scar tissue and encourages healing.

If you're on your own, you can do self massage with a foam roller and/or a very firm rubber ball. Vibrating foam rollers are especially helpful for ITBS.

If you have access to a Jacuzzi, using the powerful jets to massage the ITB can provide a great deal of relief from pain and stiffness.

When your pain has subsided significantly, you can work on stretching the ITB as demonstrated in this video.

3. Exercise and Strengthen

When your pain has subsided and you've regained a little flexibility, begin a gentle program of exercise to strengthen the muscles surrounding the ITB and to stretch the ITB itself.

Note that stretching the ITB is difficult because it is an extremely thick, tough, sticky band that resists modification or manipulation. Even so, you'll need to apply consistent, patient effort to stretching and releasing it to regain flexibility and do away with pain.

You may need to stop running for a while and instead substitute a program of exercise specifically targeting the strengthening of your hip muscles and the muscles surrounding your knees.

When you take up running again, you may want to only sprint and avoid marathons and long-distance running. Even after you take up running again, you must continue with strengthening and flexibility exercises on a regular and ongoing basis.

4. Stretch and Lengthen

Strengthening and lengthening exercises for the ITB are fairly simple and straightforward. It’s important to note that even though you probably only have ITBS on one side, you should do every stretching and lengthening exercise on both sides.

Here are four good exercises to get you started:

The Bow Stretch is one exercise that you can perform many times throughout the day is simply to stand straight; cross one foot over the other; reach straight up with both arms and stretched toward the side of the crossed over foot. You should be standing in a bow shape and feeling a good stretch all along the curved side of your body, including the ITB. Hold this stretch for twenty seconds.

If you are very flexible and have good balance, you can take it a step further by leaning down to touch the crossed over ankle with your fingertips. This will deliver a very focused stretch to the ITB. Hold this stretch for twenty seconds.
The Clamshell is another good strengthening exercise you can do before you get out of bed in the morning. This exercise strengthens the hip muscles surrounding the ITB.

To do this exercise, lie on your side with your knees bent. Your hips should be stacked, and your feet should be together. Keeping your lower knee down, raise the upper knee and hold it up for about five seconds.

Return to the starting position. Your goal is to do a total of thirty repetitions. You may find this surprisingly hard. If this is the case, begin with ten reps and build up gradually to three sets of ten.
Side Leg Lifts can also be done before you get out of bed in the morning. As with the clamshells, begin by lying on your side. Bend your bottom leg for stability and straighten the top leg.

Point your toe downward and lift your leg at a 45° angle to the back. Be sure to only exercise the leg and keep the hips stable and in place. You'll want to do three sets of ten reps for both legs.
One-Legged Squats on a Step: You can strengthen your hips, thighs and knees by standing on a step with one foot while allowing the other foot to dangle. Maintaining good posture, gradually dip the hanging foot engaging the strength of your knees, hips and thighs. Do three sets of ten repetitions on both legs.

How Long Does It Take To Recover From ITBS?

The fact is, you may never really recover from ITBS. The best way to cope with it is to stay active and be sure to do focused exercises to address your symptoms every day. Always be on the lookout for new exercises to add to your routines.

Make a habit of taking frequent mini exercise and stretch breaks throughout each and every day. This good practice will help keep your iliotibial band as flexible and pain free as possible while strengthening the surrounding muscles which support it.