As a physical therapist in Durham specializing in treating runners, I’ve encountered numerous cases of iliotibial band syndrome (ITBS). This common overuse injury, which presents as lateral (outside) knee pain, often sidelines athletes causing frustration and interrupting training schedules. Understanding the anatomy and pathology of ITBS is crucial to developing effective rehabilitation strategies. In this post, I’ll outline the three best areas of exercise to address ITBS in runners, backed by recent research.
Understanding IT Band Syndrome
The iliotibial (IT) band is a thick band of connective tissue running along the outside of the thigh, from the hip to the knee. It plays a crucial role in stabilizing the knee during activities such as walking, hiking, and running. ITBS occurs when this band becomes irritated, often due to repetitive friction against the lateral femoral epicondyle, a bony prominence on the outer part of the knee. Many times this issue is a result of lack of stability at the hip, causing the ITB to work harder to stabilize the knee..
Causes and Risk Factors of IT Band Syndrome
There are a number of factors contributing to IT band syndrome, including overuse and incomplete mechanics. Overuse injury usually occurs due to training errors, such as when an individual starts increasing their mileage without adequate rest between training sessions or does not incorporate appropriate cross training. This is typically an easy fix as incorporating rest days and cross training can help to decrease the irritation of the IT band and give the body time to adapt to increased training loads.
The next reason IT band syndrome can occur is due to incomplete mechanics. This includes weakness in the hip abductors (i.e. muscles on the outside of the hip), poor running form and leg length discrepancies. Poor running form and weakness in the hip abductors allow the knees to drift in (knee valgus) each time your foot strikes the ground. This can lead to increased pull on the IT band as it tries to keep the knee straight. Leg length discrepancies can cause a similar issue due to the difference in hip height side to side, which can be improved with properly fitted orthotics or heel lifts.
3 Important Components in Treating ITBand Syndrome
Hip Abductor Strengthening
Why it works: Strengthening the hip abductors, particularly the gluteus medius, is vital for stabilizing the pelvis and preventing excessive inward knee movement and contralateral hip drop, which can exacerbate ITBS. Research has shown that hip abductor weakness is a significant risk factor for ITBS (BioMed Central).
Side-Lying Leg Raises
How to do it:
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Lie on your side with the affected leg on top.
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Keep the bottom leg bent for support.
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Slowly raise the top leg to about 45 degrees, keeping it straight.
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Hold for a moment, then lower back down.
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Repeat for 3 sets of 15 repetitions.
Clamshells
How to do it:
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Lie on your side with the bottom leg straight and the top leg bent so your ankle is across your calf.
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Keeping your ankle on your calf, lift the top knee as high as possible without rolling back.
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Hold for a moment, then lower back down.
IT Band Stretching
Why it works: While the effectiveness of IT band stretching is debated, incorporating stretching into a comprehensive treatment plan can help maintain flexibility and reduce tension in the IT band (MDPI). Stretching the IT band can provide temporary relief and enhance overall mobility while working on the root cause of strengthening.
Standing IT Band Stretch
How to do it:
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Stand with your feet together.
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Cross the affected leg behind the unaffected leg.
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Lean away from the affected side until you feel a stretch along the outside of the hip and thigh.
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Hold for 30-60 seconds, then switch sides.
Foam Rolling or Lacrosse Ball release
How to do it:
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Position a foam roller or lacrosse ball on the side of your hip slightly toward the front to target your TFL (the muscle that inserts into the IT band).
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Use your arms and unaffected leg to control the pressure as you slowly roll around.
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Spend extra time on any tender spots, holding until the tenderness decreases.
Core Strengthening
Why it works: A strong core is essential for maintaining proper running form and preventing compensatory movements that can strain the IT band. Core stability exercises enhance the overall biomechanics of running, thereby reducing the risk of ITBS (BioMed Central).
Planks
How to do it:
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Start in a forearm plank position with elbows directly under your shoulders.
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Keep your body in a straight line from head to heels.
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Engage your core and hold for 30 seconds to 1 minute.
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Repeat 3 times.
Side Planks
How to do it:
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Lie on your side with your elbow directly under your shoulder.
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Lift your hips off the ground, forming a straight line from head to feet.
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Hold for 30 seconds to 1 minute, then switch sides.
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Repeat 3 times on each side.
Putting It All Together
Integrating these exercises into a regular routine can significantly improve the management and prevention of ITBS in runners. A typical exercise session might include:Warm-Up:
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5-10 minutes of light cardio (e.g., walking or easy jogging) to increase blood flow to the muscles.
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Strength Training:
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Side-lying leg raises and clamshells for hip abductor strengthening.
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Planks and side planks for core stability.
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Stretching:
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Standing IT band stretches and foam rolling to maintain flexibility and reduce tension.
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Cool Down:
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Gentle stretching and soft tissue massage (foam roller/lacrosse ball) to aid recovery and improve mobility.
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Conclusion
IT band syndrome can be a frustrating condition for runners, but with targeted exercises and proper management, it is possible to overcome and prevent this common injury. By focusing on hip abductor strength, IT band flexibility, and core stability, runners can maintain optimal biomechanics and reduce the risk of ITBS recurrence.
This blog provides areas of focus and simple exercises are a great foundation to resolving IT band issues. While these will get you off to a good start, they are likely not enough to get you back to the level of performance you want. As someone who treats runners every day, it takes an individualized plan and the knowledge and ability to adapt to your individual needs to help you reach your goals.
If you’ve been struggling with IT band issues that are holding you back from reaching your goals, contact us today to get started on a custom plan to help you overcome pain and injury and get back to the activities and workouts you love, pain free!
References:
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Iliotibial Band Syndrome: Current Evidence, 2023 (SpringerLink).
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Stretching and Releasing of Iliotibial Band Complex in Patients with Iliotibial Band Syndrome: A Narrative Review, 2023 (MDPI).
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Iliotibial Band Syndrome Rehabilitation in Female Runners: A Pilot Randomized Study, 2023 (BioMed Central).
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Biomechanical Risk Factors Associated with Iliotibial Band Syndrome in Runners: A Systematic Review, 2023 (BioMed Central).
