Pain in the outside of your knee? It could be IT band syndrome

·5-min read
Photo credit: lizzy thomas illustration
Photo credit: lizzy thomas illustration

What is your IT band?

Your iliotibial band (ITB), or 'IT band' as it's more commonly referred to, is a ligament-like structure that starts at your pelvis and runs along the outside of your thigh to the outside of the top of your shinbone (tibia). When you run, your IT band rubs back and forth over a bony outcrop on your knee, which helps to stabilise it.

What is IT band syndrome?

ITB syndrome (commonly shortened to 'IT band syndrome') is a common running injury. The main symptom is pain on the outside of the knee during the first five to 10 minutes of running.

It is caused if you have poor running mechanics, muscle imbalance, put on weight or start running hills, which causes your IT band to track out line, slipping out of the groove created by the bony outcrop, explains Dr Carlyle Jenkins, Chiropractor at Prohab Performance.

'As it tracks out of its natural alignment it rubs against other structures in your leg, creating friction on the band. This results in inflammation (but no swelling) and a click when you bend your knee,' she explains.

'The scarring thickens and tightens the ITB, and limits the blood flow to it. If you continue to run, you’ll feel a stinging sensation. This can make you limp after a run.'

Weak glutes, high or low arches in your feet that cause your feet to overpronate, increasing running too quickly or excessive downhill running are also common causes.

How can you spot IT band syndrome?

According to Dr Jenkins, you're likely to have IT band syndrome if you experience one of the following symptoms:

  • A sharp or burning pain on the outside of the knee. The symptoms may subside shortly after a run is over, but will return with the next run.

  • You feel tenderness on the outside of your knee if you apply pressure, especially when bending.

  • You may have problems standing on one leg on the affected side, usually due to a weak gluteus medius.

How do you fix IT band syndrome?

The first thing you should do is rest, which for many, prevents pain from re-occurring when you return to running. The second is to perform some targeted stretches and strengthening exercises (outlined below).

'They key thing in terms of fixing this is trying to fix those things that are offending the iliotibial band,' says Jordan Metzl, M.D., a sports medicine physician at the Hospital for Special Surgery in New York City. 'Sometimes the IT band is too tight, sometimes the butt muscles aren't strong enough and sometimes the feet are rolling in. All of these things can contribute to a pinch of the IT band.'

Below, you'll find exercises to loosen/lengthen the IT band, as well as exercises to strengthen the glutes, which will help to stabilise the pelvis and take the load off the IT band.

Donkey kicks

Photo credit: Erikreis / Getty
Photo credit: Erikreis / Getty

How: Get on all fours, resting your bodyweight on your knees and flattening your elbows on the floor. Keep your right knee bent as you slowly lift your right leg up behind you so your foot rises towards the ceiling. Hold that position for one second, then slowly return to the start. Perform four sets of 12 repetitions on each leg.

Why: This move strengthens your gluteus maximus and medius. Research in the journal Physical Therapy in Sport has found that these muscles are vital for keeping your ITB strong.

Side-lying clamshell

Photo credit: Lizzy Thomas
Photo credit: Lizzy Thomas

How: Lie on your side bending knees and hips to 90 degrees. Wrap a resistance band around both thighs. Lift your top knee up towards the ceiling, making sure that the insides of both feet stay together. Perform 10 to 15 reps, or until you get a burn in the outside of your hip.

Why: 'This move works your gluteus medius (on the outer surface of the pelvis). This muscle prevents your thigh from buckling inwards when you run, which is the root of ITB aches,' says Richard Scrivener, a running and injury lecturer at Premier Training International.

ITB lengthening

Photo credit: Tom Watkins
Photo credit: Tom Watkins

How: Lie on one side and position a foam roller beneath the outside of your thigh. Roll up and down from the bottom of the hip to the top part of the knee, but not over the bony prominences, either in the hip or the knee.

Why: 'Lengthening of the ITB is often misunderstood,' says Mark Buckingham, consultant physiotherapist to UK Athletics. 'It is fibrous tissue whose job is to act as a spring to bring the leg forwards in our stride. Like any elastic structure, it is good at stretching but not good at lengthening permanently, so simple stretching does not work. To lengthen it you must break the cross fibres between the sheets of fascia that make up the ITB. Therefore, manual therapy such as massage and foam rolling work best for this type of tissue. It can be uncomfortable, as the ITB has plenty of pressure nerve endings. Rolling or manual therapy with the ITB in an extended position for two minutes, four times a day is the most effective way to lengthen it.'

What else can you do to treat IT band syndrome?

'Oftentimes, a pronating foot or rolling in arch can really change the force mechanic around the knee and the hip and that's been implicated in IT band syndrome as well,' says Metzl. If your foot rolls into the middle or pronates a lot and you're getting IT band syndrome, it may be time to think about getting a bit more of a supportive shoe or an arch support in your shoe.'

How long will it take me to recover?

According to Jenkins, these are the recovery rates of IT band syndrome, depending on the severity of your injury:

Mild injury: 100% after 2-4 weeks

Average injury: 100% after 7-8 weeks

Severe injury: 100% after 9-24 weeks

If your IT band problem doesn’t get better, consult a physio or sports-medicine professional. You may need a cortisone injection to break up scar tissue and help speed healing.

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