The misery of an IT band problem can dog a runner for a long time. Since the knee pain often doesn’t kick in till you’ve run a few miles, you go out the door with hope in your heart day after day, only to have your it dashed at mile 5 or 7 or whatever your threshhold is. It’s can feel like Charlie Brown hoping this time Lucy will finally let him kick the football.
The classic treatments for IT band syndrome in runners are stretching and foam rolling the IT band itself, core stability exercise, and/or orthotics. Runners might use ice and/or anti-inflammatories as well, and sometimes rest in the hope that will allow it to “heal.”
I’ve written about the problems with ice and anti-inflammatories elsewhere, so if you haven’t read those posts definitely go take a look at them. I’ve also written about core stability extensively; you can catch up by starting here.
Let’s look at what foam rolling, stretching, and orthotics accomplish. Often these are the things that seem to help a bit, without getting you all the way better and taking a lot of time and, in the case of orthotics, money.
In ITB syndrome, the IT band, a tough band of connective tissue running down the outsides of your legs from hip to knee, gets very tight and tender to the touch. Stretching it or applying pressure can be agony. Yet afterwards you feel a bit better, at least for a while. The tension in the band is eased and your knee feels better.
So you keep doing it in the hope it will finally be freed up enough that your problem will go away, and often it doesn’t, or not fully. To really put your problem in the past you need to ask this critical question:
Why is it tight in the first place?
The answer is that it’s tight because it’s trying to do its job under difficult circumstances.
Every runner I’ve ever seen with ITBS fails to shift their weight far enough onto the sore leg. In most cases with running injuries it’s difficult to tell whether the movement pattern or the pain came first, but in this case it’s definitely the movement pattern causing the pain and not the other way around.
When you don’t quite get your weight over one of your legs in midstance — let’s say your right — your gluteus medius needs to work quite hard to keep you from falling sideways to your left. It contracts powerfully, excessively in fact, in every gait cycle. Before long you experience it, and the connective tissue leading from it that creates the necessary leverage, as very tight. And after that comes pain.
At the same time, your nervous system tries to fix the problem further by rotating your knee inward, underneath your center of gravity, since you haven’t brought your center of gravity to where your leg should be.
You can keep trying to mitigate the consequences of the knee pain this movement pattern causes by putting a support under your arch to try to prevent the knee from rotating inwards and doing things to your IT band to loosen it up, but the former rarely works and the latter means you’re actually fighting what your body is trying to do to solve the problem of your weight being in the wrong place.
No wonder these solutions aren’t terribly effective.
The one thing that works is learning to shift your pelvis so your weight goes all the way over your right leg so your gluteus medius doesn’t need to overwork nor your knee turn inwards. This requires a movement of your pelvis and spine, and this brings us back to core stability and the more effective alternative, core action.
Sometimes core stability exercise helps IT band syndrome by including a lot of strengthening work standing on one leg. The reason this works is neuromotor, not muscular: you’re learning to shift your weight all the way over the leg!
Sometimes core stability exercise doesn’t help, in which case it’s because it’s focusing entirely on training you to hold your pelvis and midsection still, and this makes it more difficult, not less, to shift your weight over your right leg.
Here’s a somewhat exaggerated video of what the core action looks like. It makes running much easier and smoother in addition to relieving stress on the IT bands. This movement is so important that I’ve made sure to teach it to every client, in every workshop, in every online programme and recorded lesson I’ve ever created.
The key factor needed to really get over IT band problems is changing how you move, and in particular how you move your pelvis and torso. For this you don’t necessarily need lengthy rehab and rest, you just need to learn how to do it, and that doesn’t have to take a long time. It’s quite possible and even common for runners who learn how to do the movements of the core to have their IT band problems go away in one day. As soon as your weight is in the right place over your leg, everything gets better.
I’ve created a free resource for you with my best lessons for improving your weight shift. Get it here:
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Jae Gruenke, GCFP, is a running technique expert and Feldenkrais Practitioner. Known as a “running form guru,” she is the Founder and CEO of The Balanced Runner™ in New York City and The Balanced Runner UK. She has helped runners from beginner to Olympian improve their form to become pain-free, economical, and fast.