Your knee pain could be attributed to IT band syndrome. Here’s what to know to sidestep the aches.
Knee pain is one of the most common aches that runners will likely experience at some point throughout their lifetime. In fact, if you get any group of runners together, there’s a high chance that at least one of them will say they’ve had or currently have knee pain.
While this pain is often associated with runner’s knee, there’s another common running related injury that can could be to blame: iliotibial band syndrome a.k.a. IT band syndrome.
The iliotibial band, or IT band, is a thick band of fascia, or connective tissue, that runs from the outside of the hip to the outside of the knee. It can easily become inflamed with a repetitive activity like running, and when that happens, it is called iliotibial band syndrome or ITBS.
As the iliotibial band reaches the knee, it narrows, and rubbing can occur between the band and the bone, which causes this inflammation, according to Jordan Metzl, M.D., a sports medicine physician at the Hospital for Special Surgery in New York City.
If you’re experiencing aches while you run and suspect you might have IT band syndrome, here’s everything you need to know about the injury, including symptoms, treatments, and tips for prevention.
What are the symptoms of IT band syndrome?
The most typical and notable symptom of IT band syndrome is pain on the outside of the knee. Because of the location of the pain, many runners mistakenly think they have a knee injury, like a lateral meniscus tear, says Metzl. But a knee injury like a tear will usually swell, so if you don’t have any swelling, and you’re consistently experiencing pain about five to seven minutes into every run, you likely have IT band syndrome, Metzl explains.
A meniscus tear also usually causes pain during many daily activities, not just running. Another way to differentiate a lateral meniscus tear from IT band syndrome is that you’ll experience a clicking sensation with a tear.
If you want an official diagnosis, it’s best to see a doctor, of course, but you should know that an MRI can only sometimes confirm a meniscus tear or ITBS, says Susan Paul, a running coach and exercise physiologist. An X-ray cannot always show ITBS, while the MRI might show a partial thickening of the band, which results from inflammation.
So, if you want to quickly self-check whether you might have IT band syndrome, look for these symptoms:
- Pain on the outside of the knee
- Pain that kicks in about five to seven minutes into a run (but not during other activities of daily living)
- No swelling or deep clicking sensation
What are some common causes of iliotibial band syndrome?
IT band syndrome can result from any activity that causes the leg to turn inward repeatedly. For example, wearing worn-out shoes, running downhill or on banked surfaces, running too many track workouts in the same direction, or simply running too many kilometres without building up slowly can all increase your risk of IT band syndrome. Weak glutes can also increase your risk, as it can cause the inward turn of the knee as you run.
Unlike many overuse injuries, however, IT band pain afflicts seasoned runners almost as much as beginners.
However, IT band syndrome is more common in women, possibly because they tend to have wider pelvises than men. “A wider pelvis means a greater degree of rotation when running, meaning more stress is placed on the IT band,” Paul explains.
If you have any of these ITBS symptoms, ask yourself these questions:
- Are your shoes worn out or do you need arch support?
- Do you frequently run downhill?
- Have you just quickly bumped up your distance rather than increasing gradually?
- Do you need to focus on glute and core strengthening?
How can you treat IT band syndrome?
The best treatment for IT band syndrome is to rest—which means fewer kilometres or no running at all for at least a couple of days. For the majority of runners, resting immediately will prevent pain from returning. If you don’t give yourself a break from running, ITBS can become chronic.
While you’re backing off on your mileage, considering cross-training to keep up your cardio. Swimming, pool running, cycling, and rowing are all great options and will help you maintain your fitness. You can also use this time to figure out what might have caused ITBS for you and how you can avoid it when you get back into running.
To stave off aches, targeted stretches and/or strength moves, ice or heat, and ibuprofen may help. With the assistance of a doctor, you may also get an ultrasound or electrical stimulation with topical cortisone (a classic but less utilized treatment).
If your IT band problem doesn’t get better, it’s definitely a good idea to see a physician or sports-medicine professional. You may need a cortisone injection to break up scar tissue and help speed healing, Metzl explains. Be aware that cortisone presents its own risks because it can weaken ligaments and tendons, which is why doctors don’t immediately offer them as a solution.
A doctor may also recommend an ultrasound-guided iliotibial bursa injection, which basically involves a steroid injected into the space between the IT band and underlying edge of the femur bone. The ultrasound allows for a more precise injection.
The last resort to treating IT band syndrome is surgery to release and mobilize the IT band, but this is very rare and for severe cases.
How can you prevent iliotibial band syndrome?
There are many things you can do to prevent IT band syndrome. The first: Train smart and consistently. Scott Murphy Halasz, P.T., D.P.T., a physical therapist at RunLab in Austin, Texas, tells Runner’s World that you have an increased chance of suffering from IT band syndrome if you ramp up your mileage too quickly. That’s why if you do start to feel the telltale IT band syndrome symptom of pain outside of your knee, you want to decrease your mileage or take a few days off.
The golden rule for increasing distance? Most experts recommend following the 10- to 15-percent rule. That means, only increase your mileage every week by 10 to 15 percent.
A few other strategies may help you prevent IT band syndrome. For starters, warm up with a short walk half a kilometre before you run. This will get your blood flowing and loosen the IT band.
Foam rolling every day for a few minutes on each side is another great way to sidestep IT band pain, Metzl says. However, avoid foam rolling any area that hurts (i.e. at the knee) and don’t roll the joints. Instead, roll out the muscles and tissues around those achey areas, particularly at the hip. You want to roll slowly from the bottom of the hip to top of knee along the outside of the leg.
Metzl also recommends strengthening your glutes and core to help take the load off the IT band.
Remember, you can’t stretch or strengthen your IT band, but you can take care of it by making sure the muscles around it are strong, as well as flexible.
