If you’re lucky, you might well go through your life without ever really knowing anything about the iliotibial band (or IT band). It’s one of those parts of the body that quietly does its job without problems until suddenly, it hurts. And it’s more likely to start hurting if you’re a runner, because IT band syndrome is one of the more common running injuries.
Like many running injuries, IT band syndrome is usually a result of overuse. When you suddenly increase the amount or intensity of the running you do and your body isn’t prepared for it, all kinds of problems can arise, with achilles tendonitis and plantar fasciitis being other common overuse injuries.
If you’re kicking off a marathon training plan, or starting running in general, it’s important to build up your running gradually to try to prevent these injuries. Strength training for runners can also help to ensure your body is ready for the impact of the sport.
We spoke to Rebecca Christenson, a specialist musculoskeletal physiotherapist at Pure Sports Medicine, for more info on what causes IT band syndrome, how you can avoid it, and how you should go about treating it. One spoiler on that last one – foam rolling might not be your best bet.
Rebecca Christenson has been a specialist musculoskeletal physiotherapist at Pure Sports Medicine since 2004, and prior to that worked for both the NHS and in elite sports with spells at Tottenham Hotspur FC Academy and Fulham FC Academy.
What is IT band syndrome?
The IT band runs down the outside of your thigh, extending from the pelvis to just below the knee and plays a vital role in stabilising the knee during running. According to Christenson there are two main theories about what IT band syndrome is: a friction injury or a compression injury.
“Initially it was thought that that band can move forwards and backwards as the knee bends and straightens. Underneath that it may be possible to cause an area of friction, which might be what we thought of as ITB friction syndrome. But then, looking at some studies, there were questions about whether the IT band does move exactly like that.”
“Another theory is that there might be some compression created around the lateral aspect of the knee [the outer part of the knee], around the tibia [shin bone], and also the femur [thigh bone].
Either way, Christenson says, “it essentially relates to possible tissue irritation which may be inflammation”.
What are the symptoms of IT band syndrome?
As with most running injuries, the primary symptom is pain.
“It’s standard to have pain on the outside of the knee,” says Christenson. “It wouldn’t really cause pain anywhere else.
“You might have coexisting problems but if you don’t have pain on the outside of the knee by the knee joint line, you probably don’t have ITB syndrome.
“Sometimes it will stop someone in the middle of the run, but the pain can hit two or three hours later. You’ll stand up and find you can’t really straighten your knee, or that you want to keep it straight.”
What causes IT band syndrome?
“It’s definitely classified as an overuse injury,” says Christenson. “Training load – the progression of that, as well as intensity and volume – is relevant.”
Your running biomechanics can also play a big part in causing IT band syndrome.
“One of the biggest things – which leads into the possibility of the compression theory – is increased angle of hip adduction, or what you’d call hip drop. That’s when you’re running and the other leg drops down in relation to the weight-bearing leg, your pelvis drops towards the weight-bearing leg.”
How do you prevent IT band syndrome?
Keeping tabs on your training workload and adding in some strength sessions are your first steps for reducing the risk of developing IT band syndrome.
“I would certainly say that it’s useful to have two strength sessions a week,” says Christenson, “and always have at least one day off, ideally more than that.
“What you plan to do the next week should relate to what you’ve done in the previous three weeks. You’ve got to take into account your most recent training as well as your more long-standing training.”
How do you treat IT band syndrome?
IT band syndrome is not an injury to try to run through.
“Unfortunately it does often require time out of running,” says Christenson. “Three to six weeks is not uncommon.”
“I’ve had patients who haven’t followed advice and have gone back earlier. The problem is you can often feel good walking quite quickly. You might have pain walking for two or three days and then you might feel good and decide to run a week later. In my experience that doesn't often work. Even if you feel good walking, it often requires a greater period of time out of running to reduce that irritation.”
While you are resting you should take the time to examine your training load and also your running biomechanics. And when you do get back to running it’s vital to build up gradually, rather than going straight in with the training workload you had before the injury.
Can foam rolling help?
Bad news for fans of self-myofascial release: it’s probably not the tonic required for your IT band syndrome.
“I would say the proportion of patients where a tight ITB is the main driver of their symptoms is incredibly low – less than 5%,” Christenson says. Since a foam roller releases tightness it won’t be of much use.
In fact, overuse of the foam roller can have a negative effect.
“Sometimes I’ll have patients who massively overuse it and cause themselves irritation higher up in the IT band,” says Christenson.
How do you work on your running biomechanics?
It’s tricky to fix any biomechanics issues without an expert at hand, but strength work in the gym can help, especially if you do it on one leg.
“A lot of people will go to the gym and do leg presses and maybe squats but they’re never on one leg,” says Christenson.
“Single-leg exercises that are aimed at the glutes and the quads, probably with some resistance, are quite important if you’re a runner.”
Try single-leg squats for starters and check your biomechanics with a mirror.
“You’re looking for good alignment,” says Christenson. “Broadly you want the pelvis to be level, and you want your knee to be over your foot rather than deviating inwards or outwards.”
You can find more useful moves, unilateral and otherwise, in our guide to leg exercises for runners.
If you are worried about your biomechanics is it best to see an expert?
“I think it’s really hard to self-manage,” says Christenson. “Unless you know what you’re starting with it’s hard to fix.”
We’ve tried a running biomechanics screening and found it useful. However, if it’s not an option at the moment for whatever reason all is not lost. If you’re consistent with your strength training to support your running, your bad biomechanics might never catch up with you.
“Even someone with bad biomechanics,” says Christenson, “if they’re sensible with their training and they’re strong I think they can get away with a lot.”
