IT Band pain is one of the most aggravating running injuries, and when it comes on will literally stop you in your tracks. It generally starts insidiously with pain developing during a run after a few miles, and then abating after running, and possibly reporting to you later, when you are walking up or down stairs and hills. When more severe it hurts all the time.
The Iliotibial Band is a thick fibrous band of connective tissue running along the outside of the leg from the hip (ilium) to the shin bone (tibia) just below the kneecap. In the hip area, the Band surrounds the Tensor Fascia Latae (TFL) and connects to the Gluteus Maximus and then runs down the leg to connect to the lateral side of the Tibia just below the knee. The band’s job is to hold the upper and lower parts of your leg stable when your knee bends. Specifically, it works with the muscles on the inside of your thigh to keep your knee from collapsing inward on every step.
Causes and Considerations
What I have found as a common tread in working with runners that present with this injury is that there are usually two or three form related issues. The main component that is consistently in the picture is a weakness and lack of stability of the lateral hip muscles (Gluteus Medius and sometime the external rotators as well) on the side that has the knee pain. This causes the hip to wander laterally on the weight bearing side, and the femur to rotate inwardly at the same time. This problem alone might cause the injury, but usually the runner will also be extending the leg out in front of the body (over-striding) in addition to holding the upper torso high and back. The knee is then dealing with increased impact stress on top of the mal-alignment.
Right ITB pain: Note lateral right hip and internally rotated femur
Right ITB pain: Note lateral right hip
The over-stride alone is often the cause of a number of knee problems.* When combined with this particular kind of instability at the hip it tends to favor IT Band pain.
Healing IT Band Syndrome
Focuses and suggestions:
- It is important to take any unnecessary pounding and impact out of your stride. So if you are extending the leg at the knee (resulting in a knee that straightens out when the leg swings forward), it is important to break this habit, as it is a leading cause of knee pain.
- Find some exercises that strengthen the lateral hip muscles. Grounding work in standing and moving will help establish a balance in your hip muscles.
- Work at relaxing your upper torso and chest.
- Work at finding postural alignment both running and walking.
- Maybe cut back on your volume and intensity. Only running up to your pain threshold, and increasing as your threshold extends.
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* Runner’s knee, Condromalacia Patella, Pes Anserine pain, torn Meniscus, etc.