What is the IT Band?

The iliotibial ("IT") band is a fibrous band that runs from the top of your hip down to the outside of your knee. Although the IT band is a fibrous band and not a muscle, it still helps to control your leg as an extension of a muscle called the tensor fascia lata. One of the most important functions of the IT band is stabilization during running. Common in runners and cyclists, if this band becomes too tight and becomes inflamed it can be problematic and can cause what is known as "IT Band Syndrome". 

IT Band Syndrome: 

IT band syndrome is the most common injury to the outside of the knee in runners, occurring in about 5-14% of the running population (1). It is generally regarded as an overuse injury due to improper running mechanics causing the IT band to become tight and rub against the outside of the knee. Other mechanisms that may explain pain from IT band syndrome include compression of the fat pad under the IT band or chronic inflammation of the fluid-filled bursa (2).  Slow joggers are usually more likely to develop IT band syndrome than other runners. 

Individuals with IT band syndrome usually report a sharp or burning pain on the outside of the knee with repetitive motion such as running or cycling. Pain from IT band syndrome usually begins 10-15 minutes into activity and running downhill or on slippery surfaces may make it worse. Some people with IT band syndrome report hearing a "click" upon flexion and extension of the knee. 

Biomechanical risk factors in the development of IT band syndrome include repetitive running or physical stress, a tight IT band, internal rotation of the knee when running, increased landing force when running, and weak/imbalanced surrounding musculature (3). 

Treatment & Management:

IT band syndrome is a fairly simple condition to treat and conservative treatment is the first line of therapy (4). Generally, people with IT band syndrome respond best to multiple therapies that provide relief as well as prevent further complications and flare-ups. This can consist of therapeutic symptom-relief options as well as strengthening and mobilization of the IT band and surrounding structures. 

For those who are only recently experiencing IT band syndrome, the goal is to reduce pain and inflammation. The only treatment that is recommended at this stage is rest and ice (5). A well balanced, anti-inflammatory diet may also be a good idea when dealing with IT band syndrome to decrease the inflammation and possibly speed healing time. 

After allowing adequate time to decrease the immediate pain and inflammation from IT band syndrome, it is important to move onto the active treatment and rehabilitative stage. This stage should consist of multiple therapies and exercises to ensure a proper recovery.

The following treatments can be helpful when managing IT band syndrome:

1. Stretching the IT Band and Surrounding Structures:

Improving length and range of motion of the IT band and surrounding muscles is commonly recommended as a treatment for IT band syndrome. The type of stretches for optimal results largely depends on the individual's biomechanics and preferences (6). Here are some common stretches that will help stretch the IT band and muscles of the hip:

Quadruped Piriformis Stretch

Standing IT Band Stretch

2. Manual Therapies:

These therapies are generally performed by a trained healthcare professional and include techniques aimed at releasing muscle tension and breaking up adhesions in the layer between the muscle and skin (fascia). Trigger point therapy is a treatment that can help improve IT band syndrome (6) and is commonly performed by chiropractors and physical therapists. Manual therapies aimed at relieving tension and adhesions in the IT band and surrounding muscles can be very uncomfortable but many people report relief of symptoms.

A common way that people may self-treat IT band syndrome or even aim to prevent it comes in the form of "foam rolling":

3. Strengthen Surrounding Musculature

Strengthening exercises of the muscles that move the hip away from the body is often recommended for the treatment of IT band syndrome (7). By strengthening these muscles it may help rehabilitate and prevent recurrence by restoring proper mechanics and taking stress off of the IT band. Here are some great therapeutic exercises to help strengthen the surrounding muscles involved in IT band syndrome:

Posterior Lunge

Clam with Band

4. Movement Modification:

While rehabilitating IT band syndrome it is critical to avoid movements and activities that make the symptoms worse. Common things to avoid include running downhill, running on slippery surfaces, stair climbers, and uncomfortable positioning on a bike for cyclists. Proper footwear is also important and orthotics could theoretically help improve and prevent IT band syndrome. 

It is important to remember that if performing any rehabilitative exercise you should always be instructed by a healthcare provider if you do not have previous experience. IT band syndrome can be a frustrating condition but will likely improve when treated conservatively. The most important thing when dealing with IT band syndrome is to avoid any activities that make it worse. Although the treatment of IT band syndrome may take some time and effort, it is very important if you want to prevent it from becoming a recurring problem.