If you’ve ever experienced knee pain, or pain along the outer thigh, you might have heard of the iliotibial band, which runs from the hip down to the knee. Considering IT band syndrome is one of the most common injuries in runners, this body part is also one of the most common causes of aches—yet it’s totally misunderstood.
Learning why the IT band can become a source of pain first requires an understanding of the anatomy. Here’s what to know.
What is the iliotibial band?
The iliotibial (IT) band is a thick, fibrous band of fascia, a type of connective tissue, that extends from the tensor fascia latae or TFL and gluteus maximus at the hip down to the knee, along the outer portion of the thigh. Along the way, it connects the pelvis (iliac crest) to just below the knee (tibia) as its name suggests. The main function of the IT band is to stabilize the knee, assist with inward rotation, and help with hip abduction.
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Contrary to popular belief, this band is a connective tissue—not a muscle—so it can’t really be stretched. Physical therapist and triathlete, Bridget Dungan, D.P.T., says that according to current research, you would need a lot of force to stretch the IT band, more than someone could generate on their own.
If you swear you experience IT band “tightness,” you may be feeling a sensation that’s caused by tightness in the muscles surrounding the hip and IT band. The most common IT band stretch (crossing one leg behind the other and driving the hip out to the side) is more of a tensor fascia latae stretch, which could be helpful if the TFL is tight. Tightness may also result from stiffness of the connective tissue, which can be alleviated by self myofascial release, in the form of massage or foam rolling.
If your experience is more painful than the average tight sensation, your IT band may be aggravated, as it crosses over bony prominences, which can cause irritation, pain, or even IT band syndrome.
What is IT Band syndrome?
IT band syndrome (ITBS) is an inflammation of this large band of connective tissue (the iliotibial or IT Band) that runs along the length of the thigh, according to Jordan Metzl, M.D., a sports medicine physician at the Hospital for Special Surgery in New York City and creator of the Runner’s World’s Iron Strength workout.
Symptoms of ITBS include sharp or burning pain along the outer part of the knee and/or soreness and pain along the outer thigh. Pain can stay localized or radiate up or down. “IT band syndrome is often attributed to ‘tightness’ of the IT band,” says Dungan.
However, Dungan says the root of the issue is usually poor body mechanics that result in friction or compression of the IT band and underlying tissue where it connects to the knee.
So how does this translate to running? Dungan says that excessive internal rotation of the hip and knee adduction (when the knee knocks inward) can cause irritation of the IT band or the fat pad that lies beneath it. This can occur as a result of weak glutes and/or poor neuromuscular control at the hip and/or ankle. She suggests that targeted strengthening and movement retraining with a movement specialist, such as a physical therapist, can help to correct these mechanics. Unfortunately, foam rolling the IT band, while it may help a little, just won’t cut it.
How to Deal With IT Band Pain
So what can you do if you’re experiencing pain along the IT band before, during, or after a run? Try these suggestions from the experts.
1. Stretch and strengthen the muscles around the IT band
There is a place for stretching in treating IT band tightness—but it’s not stretching the unstretchable. To stretch the muscles of the hip and thigh, try doing the following stretches:
This move stretches the tensor fascia latae, a muscle that runs across the hip and outside of the leg. Cross the injured leg behind the other leg and lean toward the uninjured side. First, stretch with arms overhead, creating the shape of a bow from ankle to hand with the injured IT band on the outside. Then, bring arms down to touch the ankle on the inside of the bow. Hold for 15 seconds, then release. Repeat 10 times. Perform 3 sets a day.
Place a resistance band around legs, just above the knees and lie on left side with head resting on left arm, knees bent and stacked, and feet and hips stacked. Slowly externally rotate right hip, engaging glute and drawing right knee up toward ceiling to open legs like a clamshell. Slowly lower back down. Repeat. Then switch sides. Perform the exercise slowly with emphasis on good form. Build up to 3 sets of 10 reps on each leg. When this exercise becomes easier and the leg remains pain-free during the process, you can move on to more advanced strengthening.
Side Plank With Leg Lift
Start lying on left side with legs straight and feet, knees, and hips stacked. Place left forearm on floor, elbow under shoulder, and drive it into the floor as you lift hips off the ground. You should form a straight line from shoulders to heels. This is your starting position. Lift right leg straight up, then extend the leg backward. Next, move it forward Return it to the starting position. Repeat. Then switch sides. Do not let the top hip rotate backward. Perform the sequence slowly with toe pointed down. Build up to 3 sets of 10 reps for each leg. If this feels too hard or you can’t maintain proper form, keep hips on the ground, but perform the leg lifts. Do 3 sets of 10 reps until you build up strength.
Start standing and shift weight to right leg. Balancing on right foot, send hips back and down and bend right knee to lower one-quarter of the way down into a squat. Make sure the knee stays straight over the foot and does not collapse inward. Extend arms straight out for balance. Drive through foot to stand back up. Repeat. Then switch sides.
After you master the straight quarter squat, make the exercise more challenging by mimicking running form, extending the unsupported leg behind you as you lower down and bringing it through to lift the knee in front of you as you stand up. Then you can progress to holding a medicine ball overhead.
When strong enough, eccentric strengthening works the hip abductors in the same manner in which they function during running. Stand with left foot on a step or a stair, and let the right foot hang off. Place hands on hips for balance. Raise the hanging foot by lifting hip on that side. Make sure to stay in a straight, upright position. Slowly lower the hip to the bottom of your range of motion, while staying upright. Repeat. Then switch sides. Build up to 3 sets of 10 reps on each side.
2. Strengthen the glutes
According to research performed at Stanford University, strengthening the gluteus medius and maximus is the most important step in avoiding IT band-related pain. As far as strengthening, Michael Fredericson, M.D., sports medicine physiatrist at Stanford Health Care, suggests athletes perform exercises such as clamshells, straight-leg raises in abduction, glute bridges, hip hikes, and single-leg isometric wall presses (standing next to a wall with hip and knee bent 90 degrees, drive your leg into the wall and hold).
He also developed a protocol (known as “The Fredericson Protocol for ITBS,”) to help guide athletes toward the right strengthening regimen.
3. Foam roll your muscles
The research on the effectiveness of foam rolling is not totally conclusive—a 2019 meta-analysis published in Frontiers of Physiology found that its benefits may be minor but the practice can be relevant in some cases, like for reducing muscle pain sensation. Either way, it sure does feel good to experience that “hurts-so-good” effect. Instead of focusing on the IT band, though, try focusing your foam rolling on the quadriceps, glutes, and hamstrings to help your muscles warm up and cool down before and after runs.
If you are experiencing pain before, during, or after a run, along with walking or performing daily activities such as going up stairs or standing, it could be your body telling you that you need a break. By continuously performing the same repetitive motions that are causing your pain without addressing the actual root of the issue (potentially weak hips or poor run mechanics), the only cycle you will be staying on will be one of more pain and inflammation.