What is the IT band?
The iliotibial tract/ band is a fibrous connective tissue made up of fibers from the tensor fascia lata, gluteus maximum, and gluteus medius. The IT band originates at the top of the hip, runs along the outside of the thigh, and crosses the lateral part of the knee where it attaches to the tibia. Built of dense collagen, the IT band is one of the strongest forms of connective tissue in the body and plays a vital role in stabilizing the hip and knee during high-impact activities such as running. The IT band aids strongly in hip abduction and mildly helps with hip and knee extension.
What is IT band syndrome?
Image by Dr Chaigasame MD
Iliotibial band syndrome (ITBS) is an overuse injury resulting from compression/ irritation in the upper portion of the thigh or lateral part of the knee. Runners often report pain in one or both locations where the IT band rubs against the femur's proximal portion, or pain may be prominent by the femoral epicondyle located on the outside of the knee. This pain may vary from a dull ache to sharp shooting pain that may appear to radiate the length of the thigh. At its worst, ITBS can make running impossible. In some instances, runners have reported a *popping sensation in their knee due to the IT band's inability to articulate properly with movement.
How do I know if I have issues with my IT band?
Often, one of the first symptoms a runner identifies is needle-like tingling. These sensations may feel so minor in comparison that many continue training without a second thought. With time, these symptoms may increase in frequency and intensity and may begin to present differently, especially with heel strike. If left untreated, runners may begin to have pain with palpation to the outside of the knee, and swelling may be present as symptoms worsen.
How do I treat ITBS?
Reduce your training intensity or volume
Once you begin to notice any tingling or pain-related sensations on the lateral portion of your thigh, it's essential that you back off the training. Perhaps you cut your run in half and complete the additional time on the bike. Or maybe you forgo one of your hard effort sessions during the week and choose easy mileage instead. Regardless of your approach, it's necessary to dial back the intensity.
Rolling and Massage
No, it's not taboo to roll your IT band, but it's vital that you approach rolling in the right way. Due to lack of blood flow to the IT band itself, we advise you to keep rolling light and controlled. You may find it more beneficial to use a small handheld roller such as "The Stick" if using a traditional foam roller is difficult.
Technique for Gluteus Medus/ Gluteus Maximus: Focus on the upper portion of your gluteus medus due to its interconnected relationship with the Iliotibial Ligament.
Technique for the Tensor Fasciae Latae (TFL): This muscle supports the upper portion of the iliotibial tract.
Rolling With "The Stick" : The Stick is a great and convenient way to address soreness and minor inflammation near the origin points of the IT band. It's a small, light option for treatment. If you notice this area becoming tight and irritated during or following a run, the Stick can be helpful to keep on hand for immediate relief.
Light stretching and mobility
The IT band can be difficult to stretch, and stretching can also cause a worsening of symptoms if not done correctly. Try the short routine below to help rehabilitate and reduce the chance of returning symptoms in the future.
Standing Reach: Focus on length and height with this stretch. If needed, stabilize yourself by holding onto a chair or corner of a table.
Kneeling Lean: If you have any knee discomfort, add a folded towel underneath your down knee. Again, focus on length and height when reaching overhead before leaning into this stretch.
Modified 90/90: On a mat, start in the 90/90 position. Slowly walk your hands out, providing light stretch to Gluteus Medus and Gluteus Maximus. Hold the position for 10 seconds, then walk your hands towards the side and briefly hold.
Rest and Ice
If ITBS pain has increased to the point that your gait patterns change or the pain persists even when you've stopped running, then it's time to rest. Swelling may be noticeable in the knee, it's become painful to the touch, and you've begun to second guess if you should be running or not. Consider icing the tender places, rest, and consult a medical professional with experience in running. He or she will help you come up with a treatment plan to address the problem.
In office care by a trained medical professional
Myofascial release of tensor fasciae latae (TFL), gluteus, and surrounding lateral hamstring and lateral quadriceps. Your physician may prescribe a rehab routine aimed at strengthening hip abduction and general hip stability.
How can I help prevent IT band syndrome from returning?
• Warm up
• Hydrate appropriately
• Wear properly fitting shoes
• Be mindful of increasing mileage and intensity slowly and safely
• Listen to your body and rest when needed
• Consult with a trained medical professional with experience in running to come up with a prehab routine to prevent ITBS in the future (which should include: strength training and mobility)