From causes to prevention, here's everything athletes should know about this common—yet frustrating—condition.
Photo: Tony Anderson / Getty Images
For runners, cyclists, or any endurance athletes, hearing the words "IT band syndrome" is like hearing a record scratch and come to a standstill. Unfortunately, this condition often means pain, time off from training, and a whole lot of recovery.
Here's the good news: Any athlete can take a proactive stance against IT band syndrome (sometimes known as ITBS). Below, find out what causes IT band syndrome, how to treat it, and, most importantly, how you can prevent it from happening in the future. (See: 5 Tips to Help Every Runner Prevent Knee Pain)
What Is IT Band Syndrome?
The IT band (or iliotibial band) is the thickest portion of the connective tissue that runs down the outside length of your thigh muscles, from your hip to your knee, says Cameron Yuen, D.P.T., C.S.C.S., senior physical therapist at Bespoke Treatments in New York City. (Imagine someone who's super lean and muscular: You know that dip between their quad and hamstring on the side of their leg? That's it.)
Wondering if that pain you're feeling is a result of IT band syndrome? The main sign is that the pain worsens when the knee is bent at 20 to 30 degrees—about the angle it bends when walking or steady-state running, says Yuen. The pain also worsens when you're doing activities such as running, squatting, and going up and down stairs. If you're feeling the pain somewhere besides the outside of your knee, that means it's likely not ITBS. (For example, if you're feeling pain around your kneecap, that's likely runner's knee.)
While there's no immediate need to see a health professional, it's a good idea to visit a physical therapist at least once so they can verify that you're indeed experiencing IT band syndrome and not something else, says Alex Harrison, Ph.D., C.S.C.S., a sports performance coach for Renaissance Periodization. "They can also supervise exercises to ensure you're getting the most out of them for rehab purposes," he notes.
Causes of IT Band Syndrome
Put simply, IT band syndrome results from overloading the knee from too much exercise, says Yuen. While the exact causes are still debated, it's likely that the culprit is a spike in training mileage or intensity combined with additional compression placed on the IT band as the knee bends, he notes. (Muscle imbalances can also cause all sorts of issues.)
Certain factors can also put people more at risk for IT band syndrome, says Harrison. Make sure you're following proper warm-up and cool-down protocol before long bouts of exercise, and be sure to make time for recovery between workouts. (To be fair, if you're not doing those things, you're putting yourself at risk for a lot of other injuries too.) Some running surfaces, such as downhill roads or sloped roads, can add pressure to the knee and create imbalances in the body, notes Harrison. (So if you're thinking about trying trail running, ease in slowly.) Wearing worn-out shoes can also contribute to your IT band syndrome risk. (See? Told you it was dangerous to run in old sneakers.)
That's not all: Weak hip muscles (which can cause other running pains too), uncontrolled pronation when landing, and landing with your foot across the center midline of your stride can all place additional stress on the lateral side of the knee, says Yuen. Alone, these factors are rarely enough to cause IT band pain. But when combined with a large increase in training frequency, volume, or intensity, they might just create the perfect pain cocktail to take you over the edge.
How to Prevent and Treat IT Band Syndrome
"Time off" may be two of the most dreaded words to fitness enthusiasts—but that's the recovery treatment you'll have to follow if you want to get better, says Harrison.
1. Rest and ice. First, you need to cut back for a few days on aggravating activities, like running and exercises like squats and lunges, says Yuen. You can use ice for the pain during that time as well. (No, you should not foam roll your IT band.)
2. Stretch. You should incorporate light stretches too, Harrison notes, such as the common standing IT band stretch: Standing upright, cross the right foot in front of the left foot. Press hips forward slightly and reach arms overhead and to the right, shifting hips to the left. Reverse legs and directions. (Try these other IT band stretches too.)
3. Ease back in. Next, as the pain subsides, cut your training volume by 50 percent so that you can slowly let the area adapt to training again, says Yuen.
4. Take preventive measures. Once you start training again, however, you'll want to add exercises that strengthen your glute muscles and improve your coordination in a single-leg stance. "Strengthening your hip and core muscles helps to control side-to-side knee and foot movement while running," says Yuen, which can help prevent IT-band aggravation in the future. Try:
- Side-lying leg raises: Lie on the right side of the body on a weight bench (or bed at home) with hips near the edge and legs extended, so they're hanging off the edge and feet are resting on the ground. Keep back straight, and pelvis tucked in. Lift the left leg until it's 30 to 45 degrees above horizontal, then slowly lower back to start. Do 15 reps. Repeat on the opposite side.
- Hip drop exercises: Standing on one leg, "hike up" the opposite hip and slowly lower it using the outside hip muscles of the standing leg. "Standing sideways on a set of stairs makes for a great location for the hip drop exercises," says Harrison. Do 15 reps. Repeat on the opposite side.
To prevent ITBS from haunting you again in the future, focus on your running form as you get back into training. "Look out for tendencies to drop your hips to one side, let your feet cross the midline, or overly pronating when landing," says Yuen.
And when you're increasing your mileage, do so by no more than 10 percent per week. (Ex: If you're running 10 miles this week, you should only plan to run about 11 next week.) "This increase is enough to drive adaptation, but is generally considered an amount that won't cause overtraining," he explains—or, more importantly, irk your IT band again.