How to Heal Runner’s IT Band Knee Pain (Muscle Imbalances, Technique, etc.)

Jan 3, 2011 by

How to Heal Runner’s IT Band Knee Pain (Muscle Imbalances, Technique, etc.)

Overview: In lay terms, the IT (illiotibial) Band runs from the lateral hip and attaches down below the outside of the knee. IT Band pain is one of the most common of running injuries, usually manifested in the form of pain on the side of the knee although it is sometimes felt up in to the hip area as well.

Potential Causes: In many cases, it is thought that IT Band pain is caused by a muscle imbalance caused from running downhill fast or from running on flat, even, man made surfaces in combination with over-striding/heel striking. Typically, the runner with IT Band pain has central Quadricep muscles that are too strong in relation to the Gluteus Medius and Minimus (stabilizing muscles of the butt). Since the Glutes are unable to hold tension, the IT Band is pulled tighter across the side of the knee, causing the commonly felt outside of knee pain.

The most common scenarios we see are:
1) Runners coming in the shop complaining of IT Band pain a few days after a downhill race or a long run on a flat, even surface (like a road or treadmill). Usually this type of run puts more work on the quads, which causes the imbalance to get worse and the IT Band pain to manifest.  (Many times this scenario is in combination with #2, below)
2) Over-striding or heel striking runners, especially those who run fast or do speed work.

Treatments:  Like with many injuries of this nature, the key to success is getting to the root of the problem by 1) Letting the affected area relax & calm down, 2)  Stretching to loosen up the tension, and 3) Strengthening to correct the imbalances.  Below are some specific ways to do that for IT Band.

1) Short Rest – Just enough for the area to calm down—a few days to just beyond a week is usually enough.  IT Band problems don’t necessarily get better with rest beyond a couple of weeks. Many runners report taking six months or even a year off and coming back to the same problem as soon as they start back in to a training program. This is likely due to the fact that in most cases, a muscle imbalance stays a muscle imbalance. The other piece of this is that a runner doesn’t usually change their running technique drastically after a break either.

2) Break Up Scar Tissue:  While the pain is felt down by the knee, the root of the problem is up in the hip area.  The use of Massage, a foam roller, ASTYM, or other similar treatments will help to reduce the scar tissue that can keep injury recurring.

3) Stretching & Strengthening: We see great success here at the shop with those who do ‘Side-leg lifts’, ‘Standing side leg lifts (Fire Hydrants)’, and one legged squats in order to combat the muscle imbalance.  Pair the strengthening with IT Band stretching exercises and using a foam roller.  See this great article for details on stretching exercises and foam roller usage for IT Band: Stretches & Strengthening: http://runningtimes.com/Article.aspx?ArticleID=6099&CategoryID=&PageNum=1

Foam Roller or massage deep twice a week

3a) GO UNEVEN!—Get off the road (or treadmill!) & walk the downhill: Many runners suffering with IT Band pain report that they can run much farther on an uneven surface (like grass or a dirt trail) before the pain manifests.   The more uneven the surface is that you run on, the more you can strengthen the gluteal muscles and reverse the muscle imbalance—this is key to solving the root of the problem.  In addition, walking any relatively steep downhill portions of the run will keep the quadricep muscles from being worked as hard and allow the runner to go longer without pain.

3b) Avoid Overstriding: Many runners overstride or strike their heel well out in front of their body which causes a pulling motion that puts a lot of extra stress on the IT Band.  Taking a running technique class can be very effective in helping you understand what is going on with your foot strike and how to fix it.  Most, if not all great Running Specialty Stores offer some kind of running technique class for minimal cost.  Here at our shop, we have found Zero Drop shoes (shoes with the heel and the forefoot the same distance off the ground) to be highly effective for many people suffering from IT Band pain.  In some cases, we have seen collegiate runners shake their IT Band in as little as a week simply by switching to Zero Drop shoes.  The theory here is that traditional running shoes, which have a midsole that is twice as high (& twice as heavy) in the heel as in the forefoot, actually encourage (or almost force) overstriding and heel striking because the weight of the back of the shoe pulls the heel toward the ground and the excess material under the heel catches the ground early.  In a Zero Drop shoe, the foot tends to approach the ground more parallel to the ground and land the way they would naturally if they didn’t have a shoe on.   In most runners, this effectively limits overstriding and improves running technique immediately.

3c) IT Band Strap: These straps are placed above the knee and change the point of tension on the IT Band.  In many runners they are effective at reducing the pain.  In most situations, an IT Band strap reduces discomfort but doesn’t necessarily help the injury to get better.

Medical Breakdown: http://emedicine.medscape.com/article/1250716-overview

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212 Comments

  1. These are some great tips for creating the muscle balance needed to avoid IT Band injuries. How do you feel about running on the beach? It is a fairly straight path but the uneven texture of the ground still provides a terrain for working the supporting muscles around the joints.

  2. Most of this article is good stuff! However, if the person has IT Band syndrome there will almost always be a hip component in conjunction. Stretching and strengthening will be useful in speeding recovery but, will not address the underlying adhesion and scar tissue.
    The reason why IT Band symptoms come back each year is because the root of the problem as stated in the article needs to be addressed.
    Scar tissue and adhesion can occur in the gluts, obteratur internus, piriformis, gemelus, iliacus and other muscle groups to complicate the issue.

    • Amber

      I have had IT pain for almost a year (started in Dec ’10). I rested off and on for a couple of months, not knowing what the pain was, as I had never experienced anything like this and didn’t expect it to be a big deal. After no change, I finally went to see an orthopedic Dr. and they told me I have “Runner’s Knee.” As I am reading now, Runner’s Knee and and inflamed IT band are 2 different things. Anyway, they gave me a cortisone shot in my hip and it didn’t change a thing. I started pt 2 weeks later (this was now March) and started going to a chiropractor for hip pain that I was experiencing along side all of this. Bottom line, I have continued to do all of the stretches that my pt told me to do everyday.I did stop a couple of weeks ago, due to frustration with NO CHANGE in my pain. I have taken it easy, not running for over 2 months now. I took up road biking, but even then, have pain. I don’t know what to do. I was told by my pt to consider lateral release surgery, but don’t know if it is right for me or not. I don’t want to make the problem worse. Also, I have IT pain when doing absolutely nothing, like sitting or lying in bed. Should I take an anti-inflammatory, or is it too late? Is it too late to ice as I now know is recommended? I just wonder if I have waited too long to take this seriously as an injury that could stop me from running/biking comfortably forever. If you could offer me any advice, I would really appreciate it.

      • A couple of things that I would consider well before I go to lateral release surgery are massage and ice. You can massage using a rolling pin, if that is all you have. You should massage from the knee up to the hip. A foam roller works the best because you can’t hold back when using it. Icing should help reduce inflammation at the point of soreness. You can do anything from putting a bag of frozen peas on your leg to drawing a cold bath. You can ice 3-4 times a day for 15 minutes if you have the time. There are a couple of anti-inflammatory options you can look into, too. Myomed is a topical anti-inflammatory and analgesic. Use of non-steroidal anti-inflammatory drugs(NSAIDS) can be used as directed on the bottle. Higher doses can be taken but you should consult with a medical professional before doing so. There are also braces that you can use. IT Band braces apply pressure above the knee. KT tape can also be used to take some of the strain off the knee.

      • Sophie

        Where are you now with your IT injury?? – your scenario sounds identical to mine. I’ve given up on weekly physio as there’s no change to the knee pain; if anything it’s got worse. My physio instead has recommended me to the hospital but first free apt is 13th Jan 12.

        In the meantime I’m using the foam roller and regular stretching & yoga. I have not rum for 2 months and not played netball for 3 months.

        It has been suggested that the IT band has been tight for so long that now the knee cap has pulled slightly to the right causing friction pain when I move/bend.

        I’m so frustrated any feedback would be gratefully received!

  3. Dena

    I came in to buy a foam roller hoping to help with a hip issue I’ve been struggling with. My Chiro wasn’t helping much. I don’t think he really knew what was causing the pain. I spoke to Cheryl while I was there. She was quick to notice that what I described was IT band pain…. but at the hip. I’ve had it before at the knee and I ALWAYS stretch that leg… but she was showed me a stretch superior to the one I was doing… that combined with other things described in the article… I am finally feeling like I’m making progress!! The stretch she described was to sit on the floor with the leg to be stretched at a right angle in front of you and the back leg at a right angle behind you. (Make an S with your legs.) Lean into the front ankle till you can feel tension in the IT or your glute. Leaning the leg on a counter in front of you works even better!! THANKS CHERYL!!!

  4. I fit people for running shoes and see the following over and over and over again…

    One common cause is when runners have too much support from their shoes (i.e. using stability shoes when they should be using neutral shoes). They look fine when barefoot on video, no excessive flexing. I should really do an official poll, but it is fascinating that I think +90% of the time this type of person had originally (and ignorantly) fitted themselves with stability shoes at a store who does not do fittings. The “uncrushability” of the medial posting tips the foot outward and bows the leg outward just enough that the IT band gets stretched tighter onto the knee. Running is a repetitive motion. Unfortunately, this has been a repetitive occurance when I analyze runners.

    Interesting anecdote: I have never come across a runner who has both 1) medial shin splints and 2) IT band problems (this excludes multisport athletes who cycle). Furthermore, in my experience (about 1000 fittings in +1.5 years), medial shin splints have always been accompanied by significant flexing in the video analysis and have always been helped by stability shoes (with one exception: a man who did not flex barefoot on video but felt better in stability shoes).

    Also, good points above regarding shock to the body when people use the heel cushioning as a crutch. Drills are a huge help to running form. Drills not only strengthen the body, they also give vision to the mind of the runner. These are where we dissect the running gait cycle in a manner that the athlete can feel and understand and remember, forming good habits.

    We’ve been fairly injury-free in the club over the last few years, with the exception of one of our runners being mis-fitted for stability shoes (with ensuing IT band issue). He changed to the Nike Vomero and everything has been great for 6 months now. FYI, one of his feet strikes slightly forefoot and the other slightly heel first. I think he has a leg length difference.

    Anyway, to review my main point: Even a “neutral” forefoot striker can get messed up (IT band) by a medial post if he flexes enough to put significant weight upon his heel, activating the medial posting.

  5. I’ve read a LOT of different articles on IT band issues and this is one of the best I’ve seen. It is short, to the point and actually gives useful tips for preventing future problems. Thanks!

  6. Jenny

    Thank you for this article. One of the best I’ve read. I am training for a 1/2 marathon and have struggled with shin splints continuously. I went to see a Sports Medicine Dr., who recommended a few things, including I use superfeet (green). I wore them on a 7 mile run and immediately had IT band pain after the run. I had never had any problems with my IT band before that run. I took a week off training and am just getting back to it. I removed the orthodics, but am unsure how to proceed. Do I try to work up to using the orthodics again? Or, do I give them up, assuming that they will continue to cause IT band pain? I run in neutral shoes, but after reading this am wondering if I need to switch to a zero drop shoe. I am also icing, stretching, and foam rolling…trying to beat this injury and run in my 1/2 in 4 weeks. Any insight you have would be appreciated.

    • Jenny,
      Inserts or othotics are not a long term solution to fixing shin splints. You are far better off looking at your running technique ( http://www.ltrinitiative.com ), and the surfaces you run on. A Zero Drop shoe will improve your technique and make it much easier to hold form longer. However, you can improve your technique simply by working on it! Video analysis is VERY helpful in this regard. The majority of distance runners with shin splints run with a “checkmark” (heel down, toes up) landing which causes a lot of impact and tightness at the shins. Simply flex your toes toward your face right now to feel your shins tighten. I would recommend taking a running technique class and running on uneven surfaces whenever possible. Good luck!

  7. Tim

    Thanks for the article. I had the knee issues when I found out I had ITB problems. The knee problem is gone. I did the hip lateral workouts, stretches, and even biked as well. I also bought a leg roller. The only problem I still have is when I run, after about 5 miles or so, I still get a feeling in the back of my leg where its catching. My sports doc said it could be a tendon back there that is catching my ITB because its still weak I guess. Anyways its getting annoying. What else can I do? I’ve done leg workouts to strengthens up my hamstrings, and rested, stretched more, but it still catches. Help!!!

  8. Smet

    I don’t know how many of you are still dealing with this IT BAND issue but I’ve been going through the same thing. The ONLY things that have helped are Physical Therapy, icing, massage, and CHANGING MY FORM. I was heal striking more than I realized. I’ve been working with someone and I am now striking more of the midfoot and forefoot. The visual that helped most was keeping my knees moving forward not “up” and not “staying under my body” and keep your feet more parallel to the ground trying not to be tense. Finally running again after 5 weeks of nearly nothing.
    Also, full range of motion stretching verses static has helped. It stretches the actual problem areas.

  9. Frustrated Incorporated

    i am so fed up with my IT band issues i feel like chopping off my leg and getting a prosthetic. bye bye dreams of running Boston. bye bye dreams of achieving a new PR running broad street in philly. my distance running days are dying at 30 yrs old. cruel cruel world.

  10. Gaby

    And in regards to your shin splints, I have friends who have used shin sleeves with great relief.

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