Hobble into any doctor’s office with pain on the outside of your knee and you’re likely to hobble back out with a diagnosis of Iliotibial Band Syndrome, or ITBS. In short order you’ll have a foam roller, a new set of orthotics, and some physical therapy sessions or Pilates classes.
The situation might seem dire, especially if you’ve invested yourself in training for a particular race. And with the usual therapeutic protocol your recovery may indeed seem to crawl.
But the stress that leads to irritation of the iliotibial band and pain on the outside of the knee, like so many running injuries, is created by how you’re running. If you avoid the recovery-slowing effects of ice, anti-inflammatories, and stretching and make the necessary adjustments to how you support your weight on that leg, you can be running comfortably again sooner than you might expect.
How to Cause ITBS
Your iliotibial band is a tough length of connective tissue that emerges from the muscles on the outside of your hip. Its action is likewise interwoven with the action of the muscles that work to support your weight on one leg.
When these muscles (particularly the gluteus medius) contract and shorten, they pull the top of your pelvis downwards. And just like a seesaw, this lifts up the opposite side of your pelvis, helping your free leg swing forwards.
How easy it is for the muscles to do this depends on where your weight is when you’re on one leg. If you’re well-balanced over that leg then they can do the job fine. However if you haven’t moved your weight sideways enough—if your weight is still between your two legs rather than over the one that’s on the ground—then your outer hip muscles have to work extra hard to keep you from falling over sideways and this pulls on your IT band.
In addition, since your weight (pelvis, upper body, and head) haven’t shifted over your leg, your nervous system attempts to create some support by rotating your knee inwards underneath your center of gravity. Trying, in other words, to get your leg under you.
When you go to a running store and they video you and tell you that you overpronate, or when matters worsen so that your ITB hurts where it attaches outside your knee due to this inward rotation, the inward rotation will be identified as the source of the problem.
Then the focus will be on stopping the rotation, often by putting support underneath the arch. In addition you’ll probably be given exercises to do that strengthen the outer hip muscles in an effort to keep the knee tracking forwards rather than inwards.
How to Relieve the Stress on Your IT Bands
Some of the exercises given to rehab IT bands actually do end up accidentally helping to solve the original problem. But this is because they help you learn how to move your pelvis and trunk better rather than because of any direct effect they have on your knee.
For instance hip drops and single leg squats both help you learn how to truly balance your weight over the leg, and this relieves the stress. Even sidelying leg lifts can help with this if the pelvis and waist are allowed to move rather than held still.
However other exercises actually interfere with this process by teaching you to hold your pelvis still when you move your legs. Clamshells are a classic example of this, as well as any pelvic stability exercise that involves keeping your pelvis square or level. This does not help you solve the movement problem that stresses the ITB and causes your knee to rotate in. It makes it worse.
Getting good at the seesaw movement of the pelvis so that it shifts your whole upper body and head over each foot is the key to freeing yourself completely from IT band syndrome. However this isn’t something you should try to do on purpose or to force.
Instead try the pair of free lessons I’m calling Mastering Your Weight Shift. Some of the movements will remind you of sidelying leg lifts. But the intention is actually to help you feel how the movement of your leg connects to your whole body instead of how to separate it from your body.
It’s a key skill for a runner and incredibly important if you’ve got IT band problems or have been identified as an overpronator. You might get tired and/or a little sore during the lesson; just pause the recording and rest as much as necessary. It will be worth it.
Get the lessons here:
Feeling a slight side-to-side shift of your head when you run and a modest seesaw movement of your pelvis are key elements of running technique that relieve the stress on your IT bands and stop people from wanting to put support under your arch—something the America College of Sports Medicine recommends you avoid doing.
In my practice I’ve found that when runners learn how to allow these movements to happen they stop being told in running stores that they need stability shoes. And IT band pain becomes a distant memory.
Learning is a process, but the lessons above should help you get started.