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Cross Training For Runners

Iliotibial Band Syndrome in Runners – The Complete Guide

8 Mins read

Experiencing nagging pain in the outer part of your knee? Then it’s likely a symptom of iliotibial band syndrome.

This notorious overuse injury is caused by repeated knee movements and bending on every foot strike you take while running.

ITBS is one of the most frustrating overuse running injuries. Unfortunately, it’s common in runners due to the repetitive high-impact nature of the sport.

Here’s the good news. Developing ITBS isn’t a death sentence. There are way more than a few ways to help you treat and prevent IT band syndrome.

In this article, I’ll explain

  • What is the iliotibial band
  • What causes ITBS
  • What are the symptoms of IT band Syndrome
  • How to treat ITBS
  • How to prevent ITBS
  • And so much more

Sounds great?

Let’s get started.

Enter The IT Band Syndrome

Before I delve into some of the treatment and prevention strategies for this incapacitating condition, let’s first look at the medical definition of ITBS and some of the main factors that cause it.

Iliotibial band syndrome is an overuse injury of connective tissues of the outer thigh and knee, and it’s one of the most common injuries experienced by runners from all training backgrounds and fitness levels.

IT band syndrome is usually caused by repetitively bending the knee while running. This band is mainly made up of connective tissue or fascia. This elastic group of fibers stretches along your thigh from the hip to below the knee.

Overuse can irritate and tighten the IT band. This can force the band to rub against the hip or knee, which results in swelling and pain. The rubbing may also cause inflammation in the bursa, setting the stage for trochanteric bursitis (another topic for another day).

This injury does not discriminate nor differentiate.

It can hit the beginner runner and elite runner alike.

According to research, this injury accounts for about 10 percent of all running injuries.

But what is the IT band?

The Iliotibial Band Defined

The Iliotibial band is the lower portion of the tensor fasciae latae—or TFL for short.

The IT band is not a muscle. Instead, it’s a thick tendon band of fibers that begins on the iliac crest—the border of the most important pelvis bone—outside the hip.

This band has attachments to its origin from three different muscles:

the gluteus medius, gluteus minimus, and vastus lateralis.

Next, the IT band runs down the outside of the thigh, then crosses the knee joints and inserts along the lateral segment of the kneecap—or what’s known as the patella—and into the tibia, the major bone of the lower leg.

This tendon has one primary function— ensuring lateral stability in the lower extremity—especially of the knee, as it flexes and extends through its range of motion.

Risk Factors For ITBS

Muscle weakness (and imbalances) and the high impact and repetitive nature of running increase strain and stress on the IT band, leading to pain and injury.

Here are more variables that increase your odds of getting ITBS:

  • Being bowlegged, which is a medical condition called varus deformity
  • Having poor hip or pelvic mobility
  • Ill-fitting or worn-out running shoes
  • Total knee or hip replacement
  • Running on hard surfaces
  • Bad running technique
  • Tightness in the lower leg or pelvic muscles
  • Inefficient running gait, such as overstriding.

How to Spot the Problem – The Signs of ITBS

The hallmark of iliotibial band syndrome is painful knees, especially on the outer side of the joint.

ITBS is pain and tenderness along the outer side of the knee where the bone hits above the joint, often coming with a clicking sensation. This clicking sensation is caused by the Iliotibial band tightening and cracking across the knee joint when running.

Many runners have often mistaken it for the infamous Runners Knee (and other knee injuries). But that’s not true.

ITBS is different than the classically notorious runners’ knee.

Therefore, remember that Iliotibial band syndrome isn’t a KNEE INJURY—even if you have pain and significant swelling outside the knee.

For an accurate ITBS self-diagnosis, bend your knee at a 45-degree angle.  If you feel pain outside of the knee, you might have IT band problems.

You may also have ITBS when you start feeling pain and tenderness on the lateral side of the hip or knee after a mile or two of running—Typically after around 5 to 10 minutes.

The pain is often worse when running up or down hills. And as soon as you switch to walking, the pain goes away.

Note: Keep in mind that this is a very debilitating injury. It can sideline you for weeks or even longer—especially if you don’t know how to tackle it right and relieve the pain.

Additional resource – Heart Murmurs while working out

Causes of Iliotibial Band Syndrome

Along with the biomechanical causes, mainly muscle imbalances in the lower body—especially weak glutes and hamstrings—and a lack of flexibility in the hamstrings and hip flexors, ITBS can develop due to other reasons.

Here are a few:

  • Running in improper shoes.
  • Overtraining
  • Running on banked on improper surfaces—especially banked surfaces.
  • Doing too much too soon.
  • Poor ankle range of motion
  • Too much downhill running.

There is a solution, you know

This is one of the most widespread overuse injuries among runners of all ages and training backgrounds.

That’s good news, as plenty of proven ways can help relieve the pain.

How to Treat Iliotibial Band Syndrome In runners

When it comes to preventing this painful injury, there are some things you can do.

Here is what you need to do to get back on track—no pun intended 😉

Back off

Your first line of defense against most running injuries is the widely known R.I.C.E strategy.

So at any sign of trouble, back off from running, ice the painful area two to three times a day, and apply compression using bandages or stockade to reduce inflammation and pain.

You can also use anti-inflammatory drugs such as ibuprofen to soothe the pain but take them sparingly and only in cases of extreme pain.

Let the injured area recover at its rate.

In most cases, running will only exacerbate the symptoms of overuse running injury—especially when it comes to ITBS.

It’s simple—if running hurts you, don’t do it.

How much rest you will need depends mostly on the severity of the injury.

As a general guideline, a few days off will do the trick if you spot IT band syndrome in its early stages. But if you’ve been running in pain for some time, you’ll need more rest, weeks, or even months off, away from high-impact activity.

But that doesn’t mean you must sit on your butt and do nothing. You can always cross-train and opt for activities that don’t put too much stress on the injured area.

Cross-Train Right

Anything low-impact will do. I highly recommend regular yoga practice (strength and stretch work in one mix) and regular strength exercise (add the strength moves below to your resistance training).

These practices will help you prevent IT band syndrome and fix muscle imbalances, the leading cause of most running injuries.

Returning to Running After ITBS

In most cases, ITBS stems from biomechanical problems. How fast you can return to your former running mileage depends mainly on your progress in the glute and hip strength and mobility.

The sooner you fix the muscle imbalances at the issue’s core, the smoother and pain-free your return to running will be.

If you catch ITBS before it gets serious, it would only take a few days to a few weeks off the running train for the inflammation outside the knee to settle.

Icing the injured area several times a day can speed up your recovery.

It will only take months to two months of regular strength training to undo the damage and completely recover.

So don’t give up too soon. Just be patient and give it time.

The more you work on the muscle, the stronger it will get, eventually.

How To Prevent IT Band Syndrome While Running

According to my experience and research, this problem will return to your running program after three months or even a year off.

This is most likely because most overuse running injuries result from muscle imbalances. When a muscle imbalance is left unchecked, it tends to stay so, causing many biomechanical problems.

That’s why your IT band might end up inflamed and sore after a couple of weeks of training post-recovery.

Therefore, if you are serious about warding off this condition for the long haul, you need to work on fixing the muscle imbalances that caused the injury, mainly weakness in the glutes and hips.

Strengthen your Hips and Glutes

As I stated earlier, weak glute and hip muscles have a say in ITBS development.

Of course, the iliotibial band itself cannot be strengthened, but building strength in the surrounding muscles should help prevent injury and help speed up recovery by providing support and stability to the knee joint.

Here are five strength exercises that target these areas so you can get back on track in no time:

Lateral Leg Raises

Clam Shells

Hip Raise

Hip Thrusts

Lying Glute Stretch

These simple exercises can help you strengthen the body’s largest and maybe the most powerful muscle group: the glutes. This also adds strength to your hamstrings.

You can add these exercises to any workout, or they can be used as a workout routine on their own—in fact, this is mandatory if you have the condition and are serious about returning to running as soon as possible.

Along with these five exercises, I highly recommend doing a regular core training workout.

Not just crunches and sit-ups but a well-rounded and intense routine.

Roll the IT Band

Foam rolling—a self-massage technique geared toward undoing “fascia knots”—is the best tool for stretching the IT band and relieving ITBS pain.

The pressure applied by a foam roller can help you loosen up the fascia and tendon along the IT band, which promotes mobility and relieves pain.

Here is how

Lie on your side with the roller under your leg.

Then, while using your body weight for pressure, roll your IT band from its origins in the hips down to the knee.

Stop at areas that feel unusually tender or tense and release it slowly. Just be sure never to roll a joint.

Do this simple ITB foam rolling exercise at least once a day, and make it a part of your pre-run warm-up ritual if you can.

Here is the rolling foam routine you need for better and injury-free running.

Keep Tabs on your shoes

Another tip to help you avoid overuse injuries is to replace your running shoes regularly. Worn-out shoes have less impact-absorbing properties, which may increase your IT band pain odds.

Most experts recommend replacing running every 400 to 500 miles—or around four to six months of training for the recreational runner.

Warm Up Properly

A proper warm-up is key for efficient and injury-free training. I cannot emphasize this enough. This is especially the case when trying to stay proactive about ITBS.

I recommend starting all your runs with a 5 to 15-minute dynamic warm-up. The harder the session, the more intense the warm-up.

As a rule, start with at least 5 minutes of slow jogging or power walking to increase your breathing and heart rates. Then perform a series of dynamic exercises, such as inchworms, leg swings, deep squats, lunges, etc., to activate your running muscles and get them ready for speed.

Practice Proper Running Habits

Along with cross-training, foam rolling, and strength training, ensure you are running right.

So if you are serious about preventing overuse running injuries—not just ITBS—then be sure to develop these healthy running habits:

  • Run in the proper running shoes.
  • When it comes to adding mileage, slow and gradual is the way to go.
  • Do your bulk of running on proper surfaces. Steer as much as possible of hard, concrete, and banked surfaces.
  • Work on developing proper form.
  • Keep listening to your body and re-adjust your training approach accordingly. And never ignore pain—the pain usually a sign of something going wrong—so keep an eye on it and never shun it.

Iliotibial Band Syndrome in Runners – The Conclusion

Here you have it. I think that’s it on how to treat and prevent IT band syndrome while running.

Please feel free to leave your comments and questions below.

Thank you for reading my post


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