Many runners have encountered IT band syndrome in their careers. Those who’ve had it know that it can be a debilitating injury that can keep you off the trail for a long time. Let’s take a look at what the IT band is, the factors that lead to IT band syndrome and how we treat it.
IT Band Anatomy
What is the IT band? Technically, it is called the ilio-tibial band. This refers to its origin on the iliac crest of your pelvis and its insertion at Gerdy’s tubercle on your tibia below the knee. It is a broad, thick band of fascia that runs down the outside of your thigh. There are various muscles that connect to the IT band, and the ones that we will be looking at more closely are the tensor fasciae latae (TFL), which is a hip flexor, your glutes and the vastus lateralis, which is the quad muscle on the outside of the thigh. The main thing I want stress is that the IT band is very strong and very stiff, and plays a big role in the dynamic stability and “spring in your step” when running. When the IT band isn’t pulling in the right direction or isn’t supported properly by the structures that it connects to, we can end up with pain, usually around that lateral aspect of the knee. This is the feared IT band syndrome.
Origins of IT Band Syndrome
So how does IT band syndrome happen? As with a lot of running injuries, there are two main areas that contribute to the IT band getting angry: poor dynamic hip stability and inefficient running technique. In a nutshell, both of those things contribute to changing the direction of pull on the IT band as well as putting it under more stress in all phases of your running gait pattern. Just like achilles injuries, we need to look at how we actively, passively and compressively load the IT band and how that contributes to tissue irritation.
Let’s start with the active loading of the IT band. This happens when your foot hits the ground. In order for the IT band to be loaded and supported properly in this phase of gait, your glutes need to be firing strongly. This keeps your pelvis square, holds the IT band in its proper anatomical position and keeps your knee from collapsing inward. If your glutes are not strong, your pelvis will drop which causes you to “hang” off the IT band. The IT band will rotate slightly forward, pulling in a sub-optimal anatomical position and your knee will dive in. All of these things result in the IT band having to absorb more forces when your foot hits the ground in a stretched and strained position, increasing the chances of irritation.
Next, we consider the passive loading of the IT band, which occurs when it’s stretched. We’ve already looked at how it’s actively loaded when your foot is hits the ground. Now, let’s add passive loading through imperfect running technique. If you run mostly from the knee, kicking out your foot and locking your knee every time you bring your foot forward, you might be playing with fire. Remember, the IT band starts at your pelvis and inserts below your knee on the tibia. This means that when your knee is locked, the IT band is stretched. This passive stretch on the IT band is akin to plucking a piano wire every time you kick your foot forward. Eventually, the tissue will start to hurt.
Finally, the icing on the cake: compressive loading. We compressively load the IT band with ground reactive forces. Typically, people that run with sub-optimal gait kinematics as well as trail runners that are doing a lot of vert (what goes up, must come down) have higher ground reactive forces. The IT band must store and disperse these forces repeatedly. If everything isn’t in the right alignment with the optimal amount of support, these forces are magnified, and the IT band eventually gets inflamed.
So How Do We Fix This Thing?
We’ve established that poor dynamic hip stability and not-so-great running form have actively, passively and compressively loaded your IT band for a long time, and now you’ve got yourself a healthy case of IT band syndrome. So what’s next? You guessed it: a big focus on dynamic hip stability and control (think super strong glutes) and better running form. Tissue mobility around the IT band is also important. Making sure the TFL, vastus lateralis and glutes are loosened up is key. As a side note, many patients have asked me if they should roll their IT band. There are a couple of reasons why I don’t recommend this. First, it takes an insane amount of pressure to actually deform the IT band. There have been some studies out there that suggest it takes around 4,000 lbs of pressure to deform the IT band just 1 centimeter under the tip of a pen. The thought that using a foam roller could actually stretch it and make it looser seems unlikely. Second, putting more stretch and strain on the IT band through tissue work might actually make people’s symptoms worse. I feel like my patients respond better to tissue work on the quad and TFL, freeing up the IT band to do its thing.
As we get into the off-season, take time to work on having super strong glutes, perfect your running form and keep your tissues pliable. All of these things will help you from getting IT band issues and keep putting in tons of miles in the mountains. See you on the trails!
Medical disclaimer. What I write here in no way substitutes for an in-person, thorough evaluation by a licensed Physical Therapist. As with many body issues, there can be multiple factors involved with your aches and pains, and, in some cases, more serious underlying conditions that can be manifesting as physical symptoms. It is always best to have a PT that you can see when you have concerns, so that you can make sure your personal situation is being addressed appropriately and safely. This column should, in no way, serve as a substitute for seeing a licensed medical practitioner.