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.
Dear Jae,
I’m an Italian runner in my 46……….I appreciate a lot your website and your way to approach/teach the running
My weight is 59kg
I run the marathon in less 3 hours (2h55min)
The article about the IT band seem tailored on me!!!
I’ll read it with attention.
In the same time I’m thinking to have a running clinic with you so to get your support in solving my recurring IT band problem
Ho we can do?
Thanks.
Giambattista Rota (Bergamo – Italy)
Hi Giambattista! I’d be very happy to help you, you’ll find information on working with me one-to-one online here: https://www.balancedrunner.com/work-with-us/one-to-one-training/#online. Another option is the online running technique “camp” starting May 13: https://www.balancedrunner.com/work-with-us/online-training-camps/. Please email me at jae (at) balancedrunner.com with any questions.
Great info, and very interesting! Do you think that something similar could be related to overuse of the posterior tibialis? I’ve been dealing with this issue for 9 months, and of course have been told to work on hip stability and wear supportive shoes. After reading some of your stuff I am wondering if it’s related to my pelvis not moving well. Any chance you will be writing an article about that injury?
Great question, Lisa. I haven’t seen enough runners with that particular problem to generalize as easily as I can regarding IT band problems, but at the root of things pretty much all problems come down to movement of the pelvis and overall coordination. However I’ve never seen a problem that actually benefitted from hip stability and supportive shoes.
Hello Jae, hope that all is well with you today!
Can you comment further about to foam roll or not ? You touch upon the subject of a foam roller but didn’t say anymore in the article.
Interested in your thoughts on this
Best regards
Heather
Hi Heather! I’m not an expert on this, but folk I respect in the bodywork world suggest foam rolling is unnecessarily forceful and actually may cause microtrauma and/or so much discomfort that it backfires. I think you’re better off with Feldenkrais to get to the root of movement habits and active isolated stretching for maintenance.
Jae,
my name is john and i am writing from Winnipeg, Canada. I have been dealing with left IT band syndrome since Oct 2015. I am 51. I ran mostly half marathons prior to my injury. In December of 2015, i decided to become more aggressive in treating it. I signed up for a running analysis gait. it outlined several weaknesses in my body including hips, ankles and everything under the sun. Since 2015, i have seen several physiotherapists, Chiro, acupuncture, massage therapy, cupping, rehabilitation therapists, orthotics. There has been no sustained progress. i should also mention that i have had an MRI which revealed nothing substantial and a cotisone shot. i would greatly appreciate some feedback. I am desperate to get back to running and even considered more radical alternatives such as IT band surgery or just asking my doctor to perform a scope to see if there is any underlying condition affecting my knee. i am not sure if working with someone over the internet as opposed to hands on might be the way to address this problem but at this point beggars can’t be choosers
Hello Jae,
I cannot thank you enough for these two ITBs lessons. I was repeatedly suffering from this dirty injury with the last occurrence coming when I run mountain trail marathon this January. This time it was very severe. I have tried almost anything, often painful, costly stretching & strengthening plans and physio sessions with almost or very little no effect. Until I found your website. I must admit that at first I was very skeptical but I tried – and it was like a miracle. Following one weight shift and stride lessons I was able run 5K the next day. Today I run 7K – all almost pain-free. So once again thank you very much. And one more question how can I participate in you programs? I´d need some more help to improve my running form and also to easy my excessively sedentary job (I am a translator by profession…) Have a lovely day. Petr 52 y/o
I’m very happy to hear it, Petr! I recommend you take my next Online Running Technique Camp (info here: https://www.balancedrunner.com/work-with-us/online-training-camps/) which will start in May. I also offer 1:1 work online, you can find that information here: https://www.balancedrunner.com/work-with-us/one-to-one-training/#online.
Thank you *so* much for this. It’s almost scary how fast this works: I went from an ITB flaring up after 7km, to running 35km after only 10 days. Last time my ITB got bad it took a year of physio to sort it out.
I’m thrilled to hear it, Rowan!
Hi all, I haven’t tried these specific free lessons here yet, but doing Jae’s program over the course of 4 years, including a year for the personal training, fixed my IT band problem. just saying. It’s definitely worth trying, IT band is so persistent and so sidelining otherwise.