What Is IT Band Syndrome?

The IT Band Syndrome Comprehensive Guide: Causes, Symptoms, and Treatment

By Alina Kennedy, B.Physio, CSCS

IT Band Syndrome is a common overuse injury in runners that causes pain on the outside of the knee.

IT Band Syndrome Quick Facts

  • The ‘IT’ in IT Band stands for iliotibial
  • It can also be referred to as ITBS, Iliotibial Band Syndrome, or ITB Syndrome.
  • It is very common, affecting up to 10% of runners at some point
  • It starts slowly and gradually worsens. It is not caused by trauma.
  • IT Band Syndrome is different from Runner’s Knee which causes pain at the front of the knee
  • Most people recover successfully from IT Band Syndrome after 6-12 weeks of Physiotherapy exercises.
  • Surgery/invasive treatments are not usually required.

Signs & Symptoms of IT Band Syndrome

The most common symptom of IT Band Syndrome is aching pain around the outside of the knee.

Most runners notice this pain starts during a run then lasts for several hours, and in some instances, into the next day. In more severe cases, the pain can become chronic, hurting throughout the day even during mundane daily activities like sitting, walking and climbing stairs.

What Causes IT Band Syndrome?

Although it’s called IT Band syndrome, recent research suggests that the name might be misleading. In a study published in 2016, researchers found that IT band pain is actually coming from inflamed structures directly underneath the IT Band (cysts and sensitive fatty tissue), not the IT Band itself and that the pain is caused by inflammation (or irritation) rather than actual tissue damage.

Some injuries, like broken bones and muscles tears, are painful because a specific tissue is damaged – these are called structural injuries. But not all injuries are caused by actual tissue damage. In many cases, pain is actually caused by inflammation, with no physical tissue damage at all. This is an inflammatory injury. IT Band syndrome is an inflammatory injury.

A Common Misconception

“You Need to Stretch Your IT Band”

IT Band syndrome is NOT caused by a tight IT Band and stretching (or foam rolling) it will not fix the injury. 

While it’s logical to assume IT Band tightness has something to do with IT Band Syndrome, no study to date has found any correlation. In fact, it is quite normal to have variations in IT Band tightness between people with no pain.

More importantly, there have also been no studies to show stretching and foam rolling the IT Band leads to pain relief or improved running mechanics.

Treating IT Band Syndrome

First, Rest

For most IT Band sufferers taking a break from running is unavoidable. If your pain is at a level where even short runs flair it up, then taking some time off is the best thing you can do. Running is a sport where you’ve got to keep your eyes on the long term goal. If you want to run for years to come, then taking a few weeks off to recover properly isn’t a big deal in the long term. You’ll regain your fitness and strength quickly once you’re out of pain!

IT Band Syndrome Rehab Program

An online 8-week Rehab plan for IT Band Syndrome. Step-by-step Physiotherapy program you can do at home.

Why You Can’t ‘Run Through’ IT Band Syndrome

First, it’s important to be clear that running with IT band pain doesn’t cause more ‘damage’. You’re not tearing your IT Band or wearing down your knee joint. IT band pain is coming from inflamed structures under the IT Band so by continuing to run, all you’re doing is continuing to irritate those structures. You’re not causing irreversible damage. I say this because, if you have an upcoming race that you absolutely need/want to run, in most cases that is okay as long as your pain is at a manageable level and you’re prepared to take time off after the race to recover properly.

However, although running through IT band pain doesn’t cause structural damage, there are significant side effects of running with pain that you should be aware of.

Firstly, the longer you’re in pain, the longer your recovery will take. There might be some exceptions to this rule, but it is generally true for most injuries. Our bodies are constantly changing and adapting to our situations. So if you’re in pain for weeks or months, your body will adapt to this new ‘normal’. After a while, reversing this and going back to your previous normal will be much harder and take much longer. This is why you should always deal with an injury ASAP!

One of the ways our body adapts to pain is by reducing muscle activity around the painful area. Research has shown us that during IT band pain, muscle engagement in the quads, hamstrings, and glutes significantly drops. The longer you’re in pain, the weaker those muscles are going to get.

Ultimately, running with IT Band pain is a bad idea. While you will risk losing some fitness during the break (and go mildly insane), in the longer term you’ll recover quicker and have fewer lasting side effects.

How Much Time Off Do You Need?

It depends.

I know that’s not the answer you’re looking for, but it’s different for every person and depends on a number of things. Some people can rest for as little as a week, others need several months before they can get back to running.

How do you know when you’re ready to get back to running?

1. You should be pain-free with simple daily activities like walking, sitting and climbing up & downstairs

2. Pass a Return-To-Running test (below)

3. Gradually re-introduce running with a gradually progressive program

What Your ‘Resting’ Schedule Should Look Like

While resting from running, you’re not resting from all activity. The more strength and conditioning you can do during this time, the better your return to running will be.

Cross-training, walking and strength training are critical during this time. To help you plan your ‘rest’ weeks, here’s a sample training week I give my athletes. Use this as a guide but you might need to modify it based on your routine, as well as pain levels.

Pain Management

Your number one goal during the rest period is reducing pain. Find remedies and treatments that work for you, whether it’s massage, Physio, ice baths, acupuncture or medication, the end goal is the same – pain relief.

It’s important to note here that any exercise you do during this period should not exacerbate your symptoms or increase pain for more than 30 minutes.

If your pain is significant and simple remedies aren’t working, it can be helpful talking to your doctor about stronger pain management options.

Stretching & Foam Rolling

People often mistakenly think they should foam roll the IT Band. As I mentioned earlier in the guide, IT Band Syndrome is not caused by a tight IT Band so ‘loosening’ it will not help to fix the problem. More importantly, applying hard pressure onto an irritated, inflamed area can actually cause more pain and inflammation. So don’t foam rolling directly over the IT Band. However, foam rolling and stretching the quads, glutes and hamstring muscles can actually reduce tension around the IT Band and decrease the pain.

Strength Training

Strength training is key to recovering well from IT Band Syndrome and getting back to running quickly.

Research has shown that 6-12 weeks of Physiotherapy exercises significantly reduces pain and accelerates recovery for runners. 

Related: Check-out our 8-week IT Band Rehab program

Returning to Running

How Do You Know When You’re Ready?

To test whether you’re ready to get back to running you should be able to do these 5 tests, pain-free:

  • Brisk walk for 30 minutes
  • Hop on the spot for 30 seconds
  • Perform 15 lunges
  • Hop forward 10 times
  • Hop sideways 10 times

If after all that, your pain is at a 2/10 or less, and your symptoms don’t worsen over the next 12 hours, then you’re ready to head out for a run!

The First Run Back

The goal of your first run back is to find your baseline – this is the distance you can run (at a slow, comfortable pace) pain-free. You’ll need to stop once the pain goes over 2/10 and then you’ll need to monitor your symptoms for 24 hours. There should be no extra pain later that day, or the next morning.

If your pain worsens in those 24 hours, that’s a sign that you’ve done too much and you’ve re-ignited the inflammation. Wait till the pain has completely subsided, then try again, this time don’t run as far and again, monitor your symptoms for 24 hours. Once you’ve found the distance you can run, without increasing the inflammation that is your baseline distance. In the next section, I’ll show you how to use this baseline to plan your training.

The First Week Training Schedule

Now that you are mostly pain-free and have your running baseline, you’re ready to start your first full week of training.

This schedule is a guide to help you plan your first week back. You’ll notice that there is only one run in the week that gets you to the full baseline distance. That’s because the other two runs will be at a faster pace. This variety reduces repetitiveness stress overload and injury risk.

Rebuilding Training Volume

For the first 2-3 weeks, keep your training volume the same and monitor symptoms. At this early stage, it is better to focus on strength training and slowly get your body used to running again.

If after 2-3 weeks you have had no increase in pain and your knee is handling the current training volume, you can begin slowly increasing your weekly mileage by ~10%.

Your schedule should remain similar to previous weeks with a mix of strength training, running at various speeds, and rest days. You can begin increasing your baseline distance slowly. However, continue to monitor symptoms.

ABOUT ALINA KENNEDY

ABOUT ALINA KENNEDY

Alina is an Australian Physiotherapist, Strength & Conditioning Specialist and avid runner. She works exclusively with runners in the areas of injury rehab, prevention, and performance improvement. Learn More Here

IT Band Syndrome Rehab Program

An online 8-week Rehab plan for IT Band Syndrome. Step-by-step Physiotherapy program you can do at home.

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