How to Treat IT Band ( illiotibial band ) Knee Pain Injuries in Runners

What is it?

In lay terms, the IT (illiotibial) Band runs from the lateral hip and attaches down below the outside of the knee. IT Band pain is one of the most common of running injuries, usually manifested in the form of pain on the side of the knee although it is sometimes felt up in to the hip area as well.

Potential Causes
In many cases, it is believed that IT Band pain is caused by a muscle imbalance caused from running downhill fast or from running on flat, even, man made surfaces in combination with over-striding/heel striking. Typically, a runner with IT Band pain has central Quadricep muscles that are too strong in relation to the Gluteus Medius and Minimus (stabilizing muscles of the butt). Since the Glutes are unable to hold tension, the IT Band is pulled tighter across the side of the knee, causing the commonly felt outside of knee pain.

The most common scenarios

• 1) Runners coming into a running shop complaining of IT Band pain a few days after a downhill race or a long run on a flat, even surface (like a road or treadmill). Usually this type of run puts more work on the quads, which causes the imbalance to get worse and the IT Band pain to manifest. (Many times this scenario is in combination with #2, below)
• 2) Over-striding or heel striking runners, especially those who run fast or do speed work.

Treatments

• 1) Short Rest – Just enough for the area to calm down—a few days to just beyond a week is usually enough. IT Band problems don’t necessarily get better with rest beyond a couple of weeks. Many runners report taking six months or even a year off and coming back to the same problem as soon as they start back in to a training program. This is likely due to the fact that in most cases, the muscle imbalance hasn’t been addressed or fixed by the rest. The other piece of this is that a runner doesn’t usually change their running technique drastically after a break either.

• 2) Stretching & Strengthening: Many running stores have seen great success with those who do ‘Side-leg lifts’, ‘Standing side leg lifts (Fire Hydrants)’, and one legged squats in order to combat the muscle imbalance. Pair the strengthening with IT Band stretching exercises and using a foam roller, The Stick, or the Quad Baller from Trigger Point Therapy. When used properly these devices can help to increase blood flow to the area and stretch out the tendon. A couple of great articles for this can be found from Running times – IT Band: Stretches & Strengthening or TriggerPoint Performance Therapy – Anatomy of Quads & IT Band

• 3) Get off the road (or treadmill!) & walk the downhill: Many runners suffering with IT Band pain report that they can run much farther on an uneven surface (like grass or a dirt trail) before the pain manifests. The more uneven the surface is, the more the gluteal muscles can be strengthened to help reverse the muscle imbalance—this is key to solving the root of the problem. In addition, walking any relatively steep downhill portions of the run will keep the quadricep muscles from being worked as hard and allow the runner to go longer without pain.
• 4) Avoid Overstriding: Many runners overstride or strike their heel well out in front of their body which causes a pulling motion that puts a lot of extra stress on the IT Band. Taking a running technique class can be very effective in helping a runner understand what is going on with their foot strike and how to fix it. Most, if not all great Running Specialty Stores offer some kind of running technique class for minimal cost. Zero Drop shoes (shoes with the heel and the forefoot the same distance off the ground such as the ALTRA Instinct) have been shown to be effective for many people suffering from IT Band pain. In some cases, we have seen runners shake their IT Band in as little as a week simply by switching to Zero Drop shoes. Zero Drop shoes reduce ground contact time and thus engagement of the IT Band. The theory here is that traditional running shoes, which have a midsole that is twice as high (& twice as heavy) in the heel as in the forefoot, actually encourage overstriding and heel striking. In a Zero Drop shoe, the foot tends to approach the ground more parallel to the ground and land the way it would naturally if there was no shoe on. In most runners, this effectively limits overstriding and improves running technique immediately, which has beneficial effects for IT Band sufferers.
• 5) IT Band Strap: These straps are placed above the knee and change the point of tension on the IT Band. In many runners they are effective at reducing the pain. In most situations, an IT Band strap reduces discomfort but doesn’t necessarily help the injury to get better.