IT Band Syndrome

If you are a runner, you have probably heard one of the dreaded iliotibial band syndrome or ITBS.. It seems that there is a lot of confusion, however, on what it is, and what to do about it.
The iliotibial band, or “IT band”, is a long band of connective tissue that runs along the outside of the upper leg. It crosses the outside of the knee and inserts at the very top of the tibia. While many people envision the IT band as a muscle, in reality, it is nothing more than a thickened strip of fascia. Fascia is the connective tissue that encapsulates the muscles of the entire body. The IT band serves as a connection between many of the major hip muscles and the knee. Its main function during running is stabilizing the bottom (supporting) leg during footstrike. Iliotibial band syndrome, or ITBS, is an injury to the IT band. Pain is usually felt on the outside of the knee.
ITBS accounts for somewhere between 8 and 10% of all running injuries,1 and doesn’t seem to discriminate: both recreational runners and elites suffer from this injury. IT band syndrome usually hurts after a set distance into a run—you’ll feel okay for a mile or two, but the outside of your knee will start to ache, progressing from a dull stiffness to a sharp or burning pain. It is typically worse when going down hills, and you may sometimes feel pain when sitting with your leg bent for a long time. Any activity which brings the knee into 20-30 degrees of flexion can aggravate the IT band, as this is when the band itself gets squeezed against the femur the most.
What is the first thing to check? How old are your shoes? Over a year? Get new ones. What else? Check your running surface. If you always run on one side of the road, your body may be attempting to compensate for the pitch on the road (high in the middle, low on the sides). Aside from these issues, it is probably weak hip muscles. I know a lot of runners, and most of them just like to run, and nothing else. Some of them seem to pride themselves on the fact that they do no stretching, no strength training, no cross training. All of these are very important for runners. Recent research has connected hip abductor and external rotator muscle weakness with ITBS. In a healthy and strong runner, these muscle groups keep the hip abducted and the knee externally rotated, which limits the strain on the IT band. But when these muscles are weakened, the hip adducts and the knee internally rotates after impact with the ground, crushing the IT band and the underlying sensitive tissue against the lateral femoral epicondyle. Instead of the gluteus medius and the other main hip abductors firing, the TFL (tensor fascia lata) muscle fires, which puts even more strain on the IT band.

IT band syndrome is a classic biomechanical problem. Muscular weakness and dysfunction causes a predictable and repeatable change in running mechanics, increasing strain on the IT band and causing injury. So, while the painful area is the outside of the knee, the real problem lies further up the leg. While icing, stretching, and foam rolling all have their role, a biomechanical problem ultimately needs a biomechanical solution. This is where hip strengthening exercises come in.

My personal favorite exercise for this issue is a side plank with a little something extra. I have seen many people do side planks in an aerobics class, or on one of these home video programs such as P90x. Most of these lack a movement of the top leg. It is this combination of movement of the top leg along with stabilizing of the bottom leg that is the key to correcting hip biomechanics.

Pictured below is this exercise along with a “cheater” version if this exercise is too difficult. If you can do three sets of 12 on each side, you should have no problems with your IT band.