Bodyworks: Iliotibial Band Syndrome (ITBS)

How to recognise it, how to overcome it


Posted: 5 June 2000
by Patrick Milroy

Symptoms
This mouthful causes a pain on the outside of the knee when the lower end of a sheet of gristle running from the thigh rubs over the bony prominence on the side of the knee. It only hurts when the knee is moving through a particular angle, and it is more common when running downhill.

Signs
Pressing on the tender area and moving the knee should be enough to convince you, but your doctor will want to see your running action and to check whether you are bow-legged or supinate. If you have pain on one side only it may be because you always run on a camber or have legs of different lengths!

Medical investigations
Unless the doctor thinks that there is internal damage, he will probably just check your gait and shoes. A scan can confirm the diagnosis.

What else could it be?
A pain in the outer side of the knee can also be due to a strain of the lateral collateral ligament, which hinges the knee joint, or a trapped synovium (knee lining).

Self-treatment
Ice it, ice it, then ice it some more. Also, check that you are not wearing old shoes, and try running on the other side of the road if the pain is one-sided. Lower your mileage.

Medical treatment
If your footwear or gait is causing ITBS, you may need orthoses or build-ups to the outer side of your shoe. Exercises which stretch the band can help, while ultrasound or a cortisone injection should cure the problem. Although massage is often recommended, it sometimes makes the inflammation worse.

Can you run through it?/Recovery time
Improving your biomechanics can make a dramatic difference, and you could be running properly again after a week. Ignoring the pain will probably make it worse, unless you switch to better shoes or training terrain!


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Whilst running one day I felt my left IT band getting a bit tight, I continued running on it because it was at a slow and steady pace but it just developed and within 10 minutes I had a crippling pain around my knee area. It stems from the side of the knee to the front a little and hurts every time I put pressure on it. that was 2 and a half months ago and after seeing numerous physiotherapists and doctors, they have come to the conclusion that it is to do with my IT band being overly tight and rubbing agaist my knee joint as my left leg strikes the ground. I was told that it is a very common injury and that I should be running again within about 3 weeks but as I said, it has been 2 and a half months and there hasn't been any improvement.

All I have been given to do is a few stretches on my left IT band to try and loosen it (which I have done religiously 2 or 3 times a day) and although my left leg is a bit more flexible now I still cannot run and I have noticed no improvement. I am beginning to get concerned about it and I am desperately trying to sort it out in time for the winter which has already started. Can anyone help or recommend a good specialist to go and see? At this moment I would do ANYTHING to get it sorted because this has come on the back of other injuries lasting for over 10 months now!

Cheers

Ian

Posted: 30/09/2002 at 10:03

Hi Ian.

I've had IT band problems which have been alleviated by sports massage.

Try to get a personal recommendation for a sports masseur, either another runner or the lcoal running club.

I personally think that stretching on its own doesn't do much good, it needs to be combined with massage.

Where are you located? I could recommend my physio if you are in London/SE.

Parsley.


Posted: 30/09/2002 at 21:13

Hi Parsley,

Thanks for the advice. I have had one sports massage before in my life but at the time it wasn't for an injury. After I came out though I felt injured! They really like getting in among the fibres don't they?

I live in Guernsey so unless I made a trip over to London I couldn't really go to see your physio but I am over every so often for various thing so if you can give me a contact name and address etc then I'll give it a go when I'm next over. Until then I'll try and find some recommended sports physios and masseurs over here.

Thanks for the advice.

Ian
Posted: 30/09/2002 at 22:21

Ian, I'll email you his details if that's ok. If you want to see him, you'll need to book a while in advance - he's a popular man!

Parsley.
Posted: 30/09/2002 at 22:45

yeah that's fine. My email is: ijy@hotwax.co.uk

I'll have to book well in advance anyway if I'm travelling over.

Cheers

Ian
Posted: 30/09/2002 at 22:50


cep
i had itb problems last year and can sympathise because at the time i too felt it would never go away. i'd agree that sports massage was essential to my recovery, it will hurt (a lot!) but is worth it. as has been suggested try to get someone by recommendation, maybe through your club. boring, but true, is building up your running really gradually as part of rehab, and for me, strengthening the quads with visits to the gym. not rocket science, i'm sorry, but hope this offers some sense of light at the end of the tunnel!
Posted: 01/10/2002 at 22:48

I found that rest from running for a while, cross training, rowing and recumbant bike,and stretching all helped eventually. Are your stretches just for your knee or for the upper section of the ITB also? Try stretches for your hips and glutes to get an overall effect.
Good luck and keep going.
Posted: 01/10/2002 at 23:47

Thanks for the advice, I'm open to any and all at the moment. Like I said it's been over 10 months of injury for me now so I'm getting really depressed with it and willing to try anything. I'll definately try some sports massage and I've been doing stretching and strengthening work every day. I also go to the gym every other day and make sure I do a reasonable amount of leg work. I cross train also and am able to cycle and swim without any problems.

Does anyone know though how long it is likely to last for? How long did your individual IT band injuries last for? I would like to have some kind of a target.

Cheers

Slippy
Posted: 02/10/2002 at 08:40

Slippy

I had ITBS earlier this year. After hobbling around for a month I finally abandoned my plans to run the London marathon and got treatment. After 2-3 weeks I thought my physio had fixed me. Then broke down again on a 4 mile run. Decided to rest and stretch, stretch, stretch. Was OK within 3-4 weeks and gradually started rebuilding my mileage.

Sounds like your problems are taking longer to go away. When I was suffering I discovered that in the US lots of people seem to use PattStraps. Have you heard of those? I saw quite a few people running the New York marathon with them and wondered what they were. Maybe you could check it out. The link is: http://www.fabrifoam.com/p-pattstrap.html

Neil
Posted: 02/10/2002 at 10:06

Slip,

Listen man, if its hung around this long it probably means the cause of the itb friction is due to faults in other structures (bow legs, a "short leg", collapsed arches, etc.). To fix my itbfs I had to get orthotics and even then a "varus wedge" to get my foot to land so the itb wasn't rubbing on the knee. very often upper leg and knee injuries can be traced to what are broadly called "flat feet". My advice:see a podiatrist.
Posted: 02/10/2002 at 11:45

Hi Slip,
Sorry to hear that you have had this for so long. My physio solved this problem for me by taping my knee into a more central position because the It band was tight and pulling it out laterally. This along with the usual stretches etc. seemed to work within a couple of weeks.
Posted: 02/10/2002 at 13:25

Although I've been injured now for about 10 months on and off it has only been the last 2 and a half months with ITBS. The physio I've seen tried taping it to a more central position. I found this slightly easier but a knee support was just the same and was easier to just put on and take off when you wanted.

I've been checked for any leg or structural abnormalities but I've been told that I'm fine. I've even been to see a specialist who practices the bowen technique and was told that my legs, hips and body etc were all perfectly aligned and in-balance. After reading up on the injury and getting advice I think that there were a few contributing factors.

My feet don't land "flat" on the floor when i run though, they kind of slope to outside so the outside gets the first impact with the foot rolling to the flat position. (sounds dodgy but it is subtle). Not sure if this could be anything to do with it but I've never had any problems before. I think it's called "over pronating" or something like that. Anyone know anything about that?
Posted: 02/10/2002 at 13:33

Slippyahh,
Like you I also over pronate........perhaps this could be part of the problem.
I was given excercises to try and combat this problem at the same time of my IT band problem.
Are your current shoes worn down on the outer side. Mine wear down quite quickly (every day shoes and trainers) and this does seem to put additional pressures on the lateral side of the legs.
Posted: 02/10/2002 at 13:47

Is'nt landing on the outside of the foot "supinating"? That's what I was doing with my itbfs leg. The varus wedge helps point the knee inwards (stops my bandy - leggedness) and relives the friction on the itb. Still sounds like you've to get your feet checked for orthotics. Its your call.
Posted: 02/10/2002 at 14:00

Hi all

Landing on the outside of the foot and not rolling inwards enough is called "supination". A visit to a podiatrist who can make correctly fitted orthotics should sort this out. It worked for me and cured my crippling shin splints.

You will probably need to run in a neutral shoe so that the orthotic can do its stuff - Nike Air Pegasus is one recommendation, but be guided by the podiatrist.

It took a year for the podiatrist to get the right "fit" for my orthotics, but it was worth the wait.

Parsley.

Posted: 02/10/2002 at 14:12

S, G and P
Yep, my apologies, supination is how my foot lands.


Posted: 02/10/2002 at 18:50

I had this exact same injury and thought it would never go away. I did some searching on the web and found that this pain is very often referred pain from bad mobility in the hip. I started to stretch my glutes thoroughly and within days was running without pain again. There are a number of stretching exercises that go beyond just simply stretching the ITB. They can be found on the Web.
Good Luck.
Posted: 16/09/2003 at 10:38

I've had ITB trouble since last december. I've done pretty much everything thats been suggested by previous messages, physio, stretching, got orthotics had a corti-steroid injection etc And i can honestly sympathize. ITBS is one complicated problem the only thing that doesnt seem to have been been suggested is taping ABOVE the knee. My physio suggested this, A band of zinc oxide tape across the ITB about 3 fingers width above the knee cap going 3/4 of the way round the leg (i'd recommend taping ontop of some light strapping or man will it hurt to remove!)
I did this after three weeks of running with major ITB pain and it enabled me to run 24 miles over dartmoor having been unable to walk prior to it. (not that i would recommend training with acute ITBS but it emphasizes the point)
Hopefully my description hasnt baffled u too much i havent got much of a way with words! hehe Any questions u know where i am.
good luck.

Posted: 16/09/2003 at 20:07

Hi!

Have you tried exercises to strengthen the inner quads? They worked for me. Leg extension on the weights machine worked wonders. I also got a pair of ready made £30 orthotics from a running shop as I overpronate.
Posted: 17/09/2003 at 12:48

Forgot to say that during the leg extensions the legs should be turned slightly outwards.
Posted: 17/09/2003 at 12:51

Mike, can you say where you found the gluts exercises on the web?
Posted: 17/09/2003 at 18:09

Graham,
The exercises I found were at the following link:

http://www.webgate.net/~welchiro/inj-itb.html

Have a look at the stretching link near the bottom of the page and see how you get on.

Good Luck.
Mike

Posted: 18/09/2003 at 09:02

I've had a tightness around the outside of my left knee, though I'll be honest and say I'm not certain it was ITBS. I've had it for about a month and as a result I've been resting up and taking it easy with training. Someone suggested it could be my shoes as quite a lot of problems, including posture etc. stem from the bottom up. I went along to a specialist running shop (derby runner) who suggested some motion control shoes to stop me rolling in quite so quickly and aggressively after the heel strike. After a month off I tried a steady run today for around 45 minutes and its definitely improved. Probably something to do with whatever injury having time to heal but hopefully also the shoes. I'm looking forward to building up my mileage slowly now all being well. I wanted to put this on the forum for reference and also a bit of tentative encouragement for anyone thats off with a knee prob.
Posted: 21/09/2003 at 17:11

Having quickly skipped through the earlier advice nobody seems to have suggested strengthening the hip abductors (sorry if I missed it). Of the minimal research out there on ITBFS, a fairly well controlled study (Fredericson et al. 2000), found significant hip abductor weakness in runners with ITB and good improvements in symptoms following abductor strengthening. Stretching was also part of the rehab, and the subjects had to stop pain inducing activities, so these might have been the more important factor.

If you've rested and been trying the stretches with no luck, it seems worth trying some hip abduction. The researchers used side-lying abduction and pelvic drops from standing on a step to strengthen.

Hope this helps. You may well have tried it anyway but I thought it was worth suggesting.



Posted: 21/09/2003 at 17:40

Slippyah, I would definitely see a proper sports ortho person. I have the same problem as you. I land on the outside of my foot, but when I went to the sports shop their footscan thingie said I was a neutral runner. A proper analysis since shows that if you land on the outside enough, the roll inwards is more extreme and causes overpronation (it seems to fool the footscan analysis). In short, therefore, I had the wrong shoes, but more importantly, the whole of my leg was rolling inwards on one side due to this (and a longer leg length) - the ITBS would never have got better without an othortic, and I did try all the stretches. Also, I was told that if you have torn bits of the ITBS or surrounding tissues, stretching may only be retearing them.

I think the answer is to see a proper orthotic guy and get it properly sorted.
Posted: 27/09/2003 at 11:41

Mowgli is right on the money with the hip abductors my ITB pain was a real bind for ages tried taping etc but found that strengthing my gluts in the gym along with stretches and massage was the best combo. Brace yourselves for a really painful massage none of these lovely aromatherapy experiences.
ITB pain will come back though ive found if I dont keep with the routine of stretches massage and strengthening when you are training.
I hope everyone finds their cure im sure that everyone has found different answers to this problem but that is what seemed to work for me. Best of luck.
Posted: 19/10/2005 at 21:31

I have not been able to run now for just over 4 months, each time I try I get pain on the outside of my right knee. The pain only appears after around 10-15 minutes of running and then I have to stop as it is not the sort of pain you can run through. Shortly after running, my knee hurts to walk down stairs and can often hurt the next day, sometimes to the point where I can hardly walk - hence I have given up trying to run. I have tried resting it (around 6 weeks of no exercise) and tried some stretching but nothing has helped. I am now just cycling in the gym and doing weights which I am finding really boring and just can't wait to get outside and run again with my running club. I have seen a physio who was no help at all and my doctor has referred me to an orthopadeic surgeon who I saw yesterday. He has told me I need an MRI scan an appointment for which can take 5 weeks. He seems to think it could be ITBS, if this is the case, can it be diagnosed through a scan? If it is ITBS am I doing any damage cycling? And, at the moment I feel like I am never going to get better, am I ever going to be able to run long distances again? I would love to try for the marathon next year but don't want to get my hopes up!
Posted: 23/04/2008 at 15:22

Jacqui,

Don't give up.  I am just getting over ITB after not running for 17 months and the further I could run was just 2 - 5 mins before I got knee pain on the outside of my right knee.

Pain was only when running and walking downstairs and just sometimes walking.  I could still swim, spin, cycle and do weights fine.

I have seen about 12 specialists in my quest to be 'fixed' and have had lots of treatement - massage, ultrasound, accupunture, two steriod injections, electro wave shock therpy, postural assessment, gait analysis, seen chiropractor, osteos, physios, MRI, XRay, local anaethstic injection and finally.......................... after seeing my 12th specialist he spotted that I have a leg descrepancy.  So with lots of massage around my lower back, lots and lots of glut exercises everyday  3 x a dayI have now done 2 x 15 min runs and 1 x 20 mins run and absolutely no pain whatsoever on my knee.   I have been seeing my physio for about 6 - 8 weeks and he has got me back running

Debs


Posted: 23/04/2008 at 16:45

Hi Debs

 This has definitely given me hope!! What sort of specialist have you been seeing (the 12th one!)? Can you tell me where they are based? The first physio I saw said that my right leg was out of alignment (hip, knee and ankle) and that when I walk my right knee bends inwards slightly but I never thought this would be enough to cause me so much pain though, especially as I have been running for years on and off and never had an injury. After reading lots of information on the web I feel like it is pretty pointless going through the hospital as operations don't seem to fix it and can cause more problems. What sort of glut exercises are you doing and where did you find your physio? I just saw my local one but would like to find a highly recommended one as I'm desperate not to waste any more time or money!

Jacqui 


Posted: 24/04/2008 at 15:58

Jacqui,

I have been seeing a physio based in Gunnersbury (about 5 mins from the tube). He told me that my leg discrepancy was about 1cm which usually is okay on most people but wasn't for me. I do wear othortics anyway so had these checked out just in case.   I was told not to bother with hospital or an op as they are high risk of making things worse and as none of them spotted my problem I wouldn't want them to operate on me anyway.  Have you tried seeing someone about getting orthotics to see if you need a heel lift to correct you/stop knee rolling in.

The exercises I do every day for the glut are the clam (also known as oyster) the bridge, side leg raises all of them I do either with or without a stretch band for resistance and do adductor/abductor exercises at the gym and just general stretching of the ITB - not that I ever feel the stretch.

I am off to the gym tonight and plan to do another treadmill run, about 20 mins.  So far all is good

Debs


Posted: 24/04/2008 at 17:02

I have been told i have ITB problem, pain on the right side of my knee after running about  10-20mins, been for a gait anaylsis and had new running shoes, fitted although went for a run last night but  the pain came back but not so bad, saying that only managed 3 miles .  Started some stretching excercises but is it worth investing in a knee support does that help !!


Posted: 24/04/2008 at 18:14

Strengthening the muscles which support the knee - quads and hamstrings being the major ones - is very important. Doing ongoing strengthening exercises is a great preventative tool for knee and itb problems

check out this link: http://www.bigkneepain.com/knee-exercises.html

Personally I do a body pump class at my local leisure centre which works all the major muscle groups safely.
Posted: 24/04/2008 at 18:35

The major muscle weakness areas in ITBS are gluteus medius and the abductor and adductor groups.

Most runners already have strong quads and hamstrings but the hip rotators / stabilisers tend to get overlooked in the action of running because it's in the sagittal plane, so strengthening should include these areas.

Body pump's a good workout but mainly targets the upper body - only 2 leg tracks (I used to teach it) - and it's mainly the quads and hams that get worked with a bit of glute max.


Posted: 24/04/2008 at 21:09

Hi Debs

I just wondered how your training is going? Have you managed to increase your mileage?

Since I last wrote on here, I have had an MRI scan which I have just had the results from. It didn't show up a lot except some inflamation/fluid on the outside of the knee. However, my consultant thinks my symptoms point towards ITBS (as suspected) and so gave me 2 steroid injections. That was yesterday and my knee is really aching today, similar to the sort of pain I get when trying to run. I am not sure if this is a good sign or not: on the one hand, he's obviously got the injection in the right place but on the other hand, he said I should be able to have a run today and there is no way I could manage it. Did you experience discomfort after your injections? He is also referring me to a physio so that is the next step. 

 Since my scan back in May, I have managed a couple of runs, one of which was about 2 miles but once again, the pain set in. Can you tell me what sort of training schedule you carried out when you started running after ITBS? I have been going to the gym a few times a week and using the bike and stepper machine. I have also been doing squats, lunges and weights to keep my fitness up and strengthen my leg muscles. Could any of this done any damage? 

 Hope all is going well.


Posted: 12/08/2008 at 13:42

I really love how this website is made. What cms are you using? I am using wordpress for my website http://www.sciaticnerve.net but i dont like it that much.

Regards,

Merit


Posted: 25/11/2010 at 13:27

I may actually have this.  I had injured my knee while running on grass, when my left foot came down on a hard patch and twisted a bit.  I have tried Asprin, streching, <a href="http://www.jointjuicereview.com">joint juice</a>, and just about everything but surgery.  This sounds exactly like what my knee feels like.  I can't believe I found this article.

-Jason


Posted: 01/10/2011 at 04:55

Hi all, First of all i have found this discussion very intersting and inlightening. 

background.. I started running about 18 months ago and lost about 3-4 stone and now can't get enough of running i love it but about 2 months ago i went for a run and after pushing myself too much wehn going up a big hill i began to feel some pain in my right knee (outer side). I just put it down to some muscle damage and rested it for a while. 2 weeks later i did a 14 mile Run in the Lake District for charity, the problem arose again but i pushed through (probably not the best thing but I'm not one to give up straight away) after this i had a very stiff painful knee for about 3-4 days after (stairs were horrible). I rested it again for about 4 weeks and yesterday i did a 23 mile Race in the Lake District; beat my previous time by 1:16:24 and loved it.. However the pain came back, hard at first after about mile 2/3 but died down. Tpday i have the pain in my knee but i just want to get it sorted and carry on building my running experience.

 

I am worried that the pain could be ITBS after web searching symptoms, I am willing to try anything to solve the problem and would really appriciate some advice

 

Regards

 

Ben  


Posted: 13/05/2012 at 12:40

maybe have a couple of weeks off and then do an ultra marathon?


Posted: 13/05/2012 at 17:07

Hi Ben,
Are you doing anything for rehab in your rest time?
Sounds like injury aside your running is going very well but you need to address the cause of this ITB issue as it looks likes resting alone won't deal with it.
There are multiple causes; it can be simply training error - doing too much too soon - but if that was the case with you I'd have expected it to settle quickly with rest. There is probably a bit more to it in your case.
As people have mentioned here muscle strength in glutes and quads is important. Muscle length/ tissue flexibility is also important, you may need to add in ITB and calf stretches. Control of movement is also a key factor - how well you control impact dictates what part of your body deals with the stress of running. If you tend to over pronate or your hip adducts (moves slightly towards the other leg) during impact this also puts greater stress on the ITB.
So lots to think about I'm afraid. Sometimes you need to see a Physio or sports therapist to work out exactly what's going on.
I've written a big blog piece on ITB loads of info including taping techniques and exercises here;
http://runningphysio.wordpress.com/itb/
My main point for you here is add rehab to rest then plan a gradual return to running, otherwise I think it'll just keep coming back.
Hope that helps
Tom
Posted: 13/05/2012 at 20:06

Doing too much too soon sounds like the cause! I'm still trying to recover from doing my first marathon (VLM2012 in 4:24.22) and have only been for 2 runs since completing it - 40 mins last sunday, and 40 mins of Intervals today. Due to injury & getting a charity place for Macmillan Cancer Support at the last minute I only managed 6 weeks training before starting to taper. On my final long run before the marathon I got to 19 miles and my left knee was in serious pain. This was 3 weeks before the race so my last 3 weeks of training/taper consisted of nothing week 1, 2 5k runs week 2, and a very gentle 20 min run week 3. On the day my knee felt ok (painkillers...) but afterwards it got increasingly painful. I basically did mothing for the 2 weeks after, except walking about at work. Last Sundays run made it ache for the week, and todays intervals made me need more painkillers! So basically I'm thinking too much too soon?! I read somewhere that you should take off as many days as miles you raced, before going back to training, and can't help thinking that this would have been better for me - especially as being new back to running!

PS (<span style="color: #000000; font-family: Verdana, Arial, Helvetica, sans-serif; font-size: x-small; line-height: 13px; text-align: left;">http://uk.virginmoneygiving.com/ColinHenderson if you're feeling generous!) 

<span style="color: #000000; font-family: Verdana, Arial, Helvetica, sans-serif; font-size: x-small; line-height: 13px; text-align: left;">


Posted: 13/05/2012 at 21:08

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