"The IT band runs from the outside part of the hip across the hip joint and across the knee joint. When that tendon gets too much pressure put on it—and after a combination of too much force and excessive rubbing on the outside of the knee—it gets irritated and inflamed and causes the sharp pain on the outside of the knee called iliotibial band syndrome," says Jordan Metzl, MD, author of The Sports Doctor's Complete Guide to Staying Healthy and Injury-Free for Life. "As a sports medicine doctor, this time of year—as people are in marathon-mode—I see at least two or three cases of ITBS a day. It's a very common injury in runners—ones who are trying to do long-distance running."
While ITBS is common in runners, that's not the only group it affects. According to physical therapist Danielle Weis, PT, DPT, it's often seen in individuals who do any sort of repetitive knee bending and straightening, like running and cycling. "As the knee moves through the normal motions of extension (straightening) and flexion (bending), the IT band moves back and forth over the epicondyle. In individuals with muscular imbalances, tightness, poor alignment, and faulty biomechanics and movement patterns, this once normal motion can create excess friction that leads to irritation and an inflammatory response," she explains.
How to deal with ITBS
After ITBS occurs, you won't just feel the pain and tenderness on the outside of your knee while exercising. You'll also have to deal with it while doing any activity that requires the knee to bend, like walking and climbing stairs. And when it comes to exercising with ITBS, Weis says a good rule is to avoid anything that triggers the pain.
"Keep workouts as pain-free as possible. Pain should not get worse after the workout, either. If it does, cut the exercise that irritated it," she says. "You also want to avoid activities that will continue to irritate the area and cause inflammation. Swap cycling and running for swimming or walking, and make sure to do a lot of calf, quad, hamstring, and hip stretching. Also avoid foam rolling an irritated IT band, as that can make it worse."
Basically, it's a good excuse to breathe and do a little self-care—as well as plenty of icing of your knee and lower thigh after any sort of workout until it heals. Then once it does, switch your focus on doing exercises that can help prevent the issue in the first place.
How to prevent ITBS
While there are many different reasons behind IT band issues, they're easy to prevent. Since the IT band's primary function is supporting and stabilizing the pelvis, thigh, and knee during movement, you have to make sure your muscles are strong enough to do so.
"One reason people have this problem is simply because their butt muscles aren't being strengthened," Metzl says. "Because of that, the muscles on the back and side of their hips aren't strong enough to support themselves when they run, causing the ilitibial tract and the muscles on the outside of the hip to become overworked. Another reason is sometimes the muscles on the outside part of the hip are too tight."
According to Cameron Yuen, PT, DPT, CSCS of Bespoke Treatments NYC, there's another important area to strengthen to drastically reduce the likelihood of developing ITB syndrome too: Your core. Between a handful of strengthening exercises and some foam rolling to combat tightness, you'll be in a pretty good place to make sure you can hit your running or cycling goals without shooting pain.
IT band exercises that help combat ITBS
After experiencing ITBS, Yuen recommends first taking the time to let your body heal by ditching any aggravating activities, like running, squats, and lunges. "Next, cut your training volume by 50 percent so that you can slowly let the area adapt to training again," he says. "This time, however, you will want to add exercises that strengthen your glute muscles and improve your coordination in single leg stance." And that's best done in two main parts: foam rolling and strengthening.
Foam roll:
1. Tensor fascia latae (TFL)
Bespoke Treatments NYC: "This is used to help mobilize the tensor fascia latae, which connects into the iliotibial band. You can foam roll the TFL in preparation or for cool down before or after a workout. This can be used to help improve tissue mobility and improve recovery, and alleviate knee or hip pain."
2. Hip flexors and quads
Bespoke Treatments NYC: "Releasing trigger points helps to reestablish proper movement patterns, resulting in pain-free movement, and ultimately enhances performance. You may be sore the next day. It should feel as if your muscles have been worked/released, however you should not push yourself to the point of excessive soreness."
Strengthen:
1. Lateral stepping
Perform 3 reps of 15 to 20 on each side
2. Standing fire hydrants
Perform 3 reps of 15 to 20 on each side
3. Single leg deadlift
Perform 3 sets of 10 to 15 on each side
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