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Most runners have experienced pain related to the sport at one time or another. Knee pain is a common occurrence, and sometimes, this might be paired with aches along the outer thigh and/or hip, which often has to do with the iliotibial band a.k.a. the IT band.
Illotibial band syndrome is a common running aliment and one that’s frequently misunderstood. Getting a better understanding of the anatomy surrounding this area can help you best treat IT band issues, including learning the ideal IT band stretches and exercises.
Here’s everything to know about taking care of your IT band so you can run ache-free.
What is the iliotibial band?
The iliotibial (IT) band is a thick, fibrous band of fascia, a type of connective tissue, that extends from the tensor fascia latae or TFL and gluteus maximus at the hip down to the knee, along the outer portion of the thigh. Along the way, it connects the pelvis (iliac crest) to just below the knee (tibia) as its name suggests. The main function of the IT band is to stabilize the knee, assist with inward rotation, and help with hip abduction.
Contrary to popular belief, this band is a connective tissue—not a muscle or a tendon—so it can’t really be stretched. Physical therapist and triathlete, Bridget Dungan Twedt, D.P.T., of High Road Physical Therapy in Norwalk, Connecticut says that according to research, you would need a lot of force to stretch the IT band—more than someone could generate on their own.
If you swear you experience IT band “tightness,” you may be feeling a sensation that’s caused by tightness in the muscles surrounding the hip and IT band. The most common IT band stretch (crossing one leg behind the other and driving the hip out to the side) is more of a tensor fascia latae stretch, which could be helpful if the TFL is tight. Tightness may also result from stiffness of the connective tissue, which can be alleviated by self myofascial release, in the form of massage or foam rolling.
If your experience is more painful than the average tight sensation, your IT band may be aggravated, as it crosses over bony prominences, which can cause irritation, pain, or even IT band syndrome.
You may also experience the pain more when you run slowly, as some fibers of the IT band runs down to the knee and can make runners think they should back off their speed. If the pain sends you to the doctor, be sure to mention this symptom.
What is IT Band syndrome?
IT band syndrome (ITBS) is an inflammation of this large band of connective tissue (the iliotibial or IT Band) that runs along the length of the thigh, according to Jordan Metzl, M.D., a sports medicine physician at the Hospital for Special Surgery in New York City and creator of the Runner’s World’s Iron Strength workout.
According to research, IT band pain is highly prevalent in endurance athletes such as cyclists and runners, with more than 15 percent of cyclists and 22 percent of runners experiencing it.
Symptoms of ITBS include sharp or burning pain along the outer part of the knee and/or soreness and pain along the outer thigh. Pain can stay localized or radiate up or down. “IT band syndrome is often attributed to ‘tightness’ of the IT band,” says Twedt.
However, Twedt says the root of the issue is usually poor body mechanics that result in friction or compression of the IT band and underlying tissue where it connects to the knee.
So how does this translate to running? Twedt says that excessive internal rotation of the hip and knee adduction (when the knee knocks inward) can cause irritation of the IT band or the fat pad that lies beneath it. This can occur as a result of weak glutes and/or poor neuromuscular control at the hip and/or ankle.
She suggests that targeted strengthening and movement retraining with a movement specialist, such as a physical therapist, can help to correct these mechanics. Unfortunately, foam rolling the IT band, while it may help a little, just won’t cut it.
How to Deal With IT Band Pain
So what can you do if you’re experiencing pain along the IT band before, during, or after a run? Try these suggestions from the experts.
1. Stretch and Strengthen Muscles Around the IT Band
There is a place for stretching in treating IT band tightness—but it’s not stretching the unstretchable. To stretch the muscles of the hip and thigh, try doing the following moves:
Lengthening Stretch
How to do it:
- Cross the injured leg behind the other leg and lean toward the uninjured side.
- First, stretch with arms overhead, creating the shape of a bow from ankle to hand with the injured IT band on the outside.
- Then, bring arms down to touch the ankle on the inside of the bow. Hold for 15 seconds, then release.
- Repeat 10 times. Perform 3 sets a day.
Clam Shell
How to do it:
- Place a resistance band around legs, just above the knees and lie on left side with head resting on left arm, knees bent and stacked, and feet and hips stacked.
- Slowly externally rotate right hip, engaging glute and drawing right knee up toward ceiling to open legs like a clamshell.
- Slowly lower back down. Repeat. Then switch sides. Perform the exercise slowly with emphasis on good form.
- Build up to 3 sets of 10 reps on each leg.
Side Plank With Leg Lift
How to do it:
- Start lying on left side with legs straight and feet, knees, and hips stacked.
- Place left forearm on floor, elbow under shoulder, and drive it into the floor as you lift hips off the ground. You should form a straight line from shoulders to heels. This is the starting position.
- Lift right leg straight up, then extend the leg backward.
- Next, move it forward to return to the starting position. Do not let the top hip rotate backward. Perform the sequence slowly with toe pointed down.
- Repeat. Then switch sides.
- Build up to 3 sets of 10 reps for each leg. If this feels too hard or you can’t maintain proper form, keep hips on the ground, but perform the leg lifts.
Single-Leg Squat
How to do it:
- Start standing and shift weight to right leg.
- Balancing on right foot, send hips back and down and bend right knee to lower one-quarter of the way down into a squat. Make sure the knee stays straight over the foot and does not collapse inward. Extend arms straight out for balance.
- Drive through foot to stand back up.
- Repeat. Then switch sides.
- After you master the straight quarter squat, make the exercise more challenging by mimicking running form, extending the unsupported leg behind you as you lower down and bringing it through to lift the knee in front of you as you stand up.
Hip Hike
How to do it:
- Stand with left foot on a step or a stair, and let the right foot hang off.
- Place hands on hips for balance. Raise the hanging foot by lifting hip on that side.
- Make sure to stay in a straight, upright position.
- Slowly lower the hip to the bottom of range of motion, while staying upright.
- Repeat. Then switch sides.
- Build up to 3 sets of 10 reps on each side.
2. Strengthen the Glutes
According to research performed at Stanford University, strengthening the gluteus medius and maximus is the most important step in avoiding IT band-related pain.
As far as strengthening, Michael Fredericson, M.D., sports medicine physiatrist at Stanford Health Care, suggests athletes perform exercises such as clamshells, straight-leg raises in abduction, glute bridges, hip hikes, and single-leg isometric wall presses (standing next to a wall with hip and knee bent 90 degrees, drive your leg into the wall and hold).
He also developed a protocol (known as “The Fredericson Protocol for ITBS,”) to help guide athletes toward the right strengthening regimen.
3. Foam Roll
The research on the effectiveness of foam rolling is not totally conclusive—a 2019 meta-analysis published in Frontiers of Physiology found that its benefits may be minor but the practice can be relevant in some cases, like for reducing muscle pain sensation.
Either way, it sure does feel good to experience a sort of massage for your fascia. Instead of focusing on the IT band, though, try focusing your foam rolling on the quadriceps, glutes, and hamstrings to help your muscles warm up and cool down before and after runs.
Foam rolling may also help becauese it loosens adhesion between the band and underlying tissues. It may be uncomfortable, at first, but after a few moments, you may feel a release that eases the tension.
4. Rest
If you are experiencing pain before, during, or after a run, along with walking or performing daily activities such as going up stairs or standing, it could be your body telling you that you need a break. By continuously performing the same repetitive motions that are causing your pain without addressing the actual root of the issue (potentially weak hips or poor run mechanics), the only cycle you will be staying on will be one of more pain and inflammation.
John Vasudevan, M.D. is an associate professor at the University of Pennsylvania. He is board-certified in Physical Medicine & Rehabilitation and Sports Medicine. He is a Team Physician for UPenn Athletics and medical director of the Broad Street Run and Philadelphia Distance Run, and previously for the Rock 'n' Roll Half-Marathon and Tri-Rock Triathlon in Philadelphia. He is a director of the running and endurance Sports Medicine Program at Penn Medicine. Dr. Vasudevan provides non-operative management of musculoskeletal conditions affecting athletes and active individuals of all levels, and combines injury rehabilitation with injury prevention. He utilizes a variety of ultrasound-guided procedures and regenerative approaches such as platelet-rich plasma and percutaneous ultrasonic tenotomy. He sees patients at the Penn Medicine and the Philadelphia Veterans Administration hospital. Dr. Vasudevan attended medical school at the University of Wisconsin School of Medicine and Public Health in Madison. After his Transitional Year in Tucson, Arizona, he went to residency in PM&R at Thomas Jefferson University in Philadelphia and onwards to Stanford University for his fellowship in Sports Medicine. He has been in practice at the University of Pennsylvania since 2012.
