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ITB Syndrome: What causes it and how can you fix it?

Updated: Nov 27, 2018

Iliotibial band syndrome (ITB syndrome) can be a pesky problem to get rid of and its one of the few injuries that affect more male runners than females. I actually did my masters dissertation on this subject, but found that like with most sports injuries ITB syndrome can have many causes. And the key to finding an effective treatment plan for your case of ITB syndrome lies in figuring out exactly what caused yours in the first place.

In this article:

  • What does the ITB look like?

  • What does the ITB do?

  • What caused ITB syndrome?

  • How long does ITB syndrome take to recover?

  • What treatment works for ITB syndrome?


What does the ITB look like?


The Iliotibial band (IT band or ITB) is made of thick fibrous fascia that is extremely strong. Facia is the white sinewy stuff that you find in meat. It may help to picture it as the same material that a car’s safety belt is made of.


It runs from the top of the pelvis over the side of the hip, down the side of the thigh and attaches to the outside of the knee and kneecap.


The ITB itself is not very flexible and it’s not really possible to stretch it. I know! You’ve been taught stretches for the ITB in the past, but give me a moment to explain.


There are several muscles that attach into the ITB including the Glute Max, Tensor Fasciae Latae and Lateral Quadriceps muscle. If these muscles become tight and inflexibile, they pull the ITB taut and then people wrongly blame the ITB for being too tight. In fact, it’s the fault of the muscles that attached into the ITB.


So instead of trying to stretch the ITB, it works much better if you aim your stretches at the muscles that attach onto it. I’ll give you some examples later in the article.

What does the ITB do?


It helps to stabilise your pelvis on your leg when you walk or run or jump. As mentioned above, the ITB can get pulled tight when the muscles that attaches into it contracts and tugs on it.


Not only is the ITB made of thick fibrous material like a safety belt, but it also acts as a “safety belt” for the pelvis and stops it from dropping as you walk (thanks to the muscles pulling it tight). You may understand this better if you watch my explanation/demonstrating in the video about the causes for ITB syndrome.

What causes ITB syndrome?


ITB syndrome is caused when the ITB is pulled tight over the outside of the knee, causing it to squash against and rub on the bone as you bend and straighten your knee during running. This not only causes the ITB itself but also the other stuff that lies between the ITB and the bone to become inflamed and sore.


When running, the worst point or maximum compression usually happens just after your heel makes contact with the ground, when your knee is bent at about 30 degrees.


Some of the reasons why the ITB may be pulled too tight include:

  • If the muscles that attaches into the ITB (Glute max, TFL, Lateral Quad) are tight and pulls it taut.

  • If your hip muscles aren’t strong and allows your pelvis to drop as you run – Glute Max and Glute Med are usually the main culprits. Because the ITB attaches onto the pelvis, it gets pulled tight when the pelvis drops.

  • If you’ve done a really tiring run e.g. long downhill race. You may normally have strong hip muscles, but if you make them very tired they may not be able to stabilise the pelvis, causing it to drop and pull the ITB taut.

  • Downhill running can cause trouble. I’m often guilty of just letting go and plonking down a hill, but this can cause a lot more impact on your legs.

  • Running on an incline or camber of a road can also cause the ITB on your one leg to pull tight over the side of your knee.

  • If your one leg is shorter than the other it can also cause the ITB on the longer leg’s side to pull tight.

  • Excessive pronation in your foot (when your foot rolls in) can cause your leg to turn in more, potentially causing the ITB to pull tight.

How long does ITB syndrome take to recover?


If you’re lucky and you treat it right from the start, it will take between 6 to 12 weeks. If you neglect it and try to run through it for a while, it can take a lot longer. Get some guidance and a treatment plan early on from someone who knows what they’re talking about.


What treatment works for ITB syndrome?


As you can see, ITB syndrome can have many causes and that’s why there is no one-size-fits-all treatment for it. You have to identify your cause and work on that.

Relative rest

This is key to getting rid of ITB syndrome. You have to cut out all aggravating activities. This doesn’t mean that you necessarily have to stop running. Some of my patients find that they just have to keep their runs short or play with their running style. I explain this in more detail in the video above.


If you find that you can’t run, then try and keep your fitness by doing other activities like cycling, swimming or using a cross trainer.


Strengthening exercises

If you have poor hip stability you may likely benefit from strengthening up your Glute Max and Glute med. Make sure that you choose exercises that does not cause pain in your knee!


Exercises like single leg squats or lunges are usually not useful at the start when the ITB is still very sore. Leave them for later and choose ones e.g. the clam or double leg glute bridge to start with.


Stretches

You should aim to stretch all the muscles that attaches onto the ITB. These include the Glute Max, TFL and Lateral Quad. Make sure that you choose ones that doesn’t cause pain at your knee.


Self-massage or foam rolling

Self-massage using a foam roller or massage ball can be very effective. Don’t just hammer the poor ITB. Massage all the muscles that attaches onto the ITB (Glute Max, TFL, Lateral Quad). I explain this in more detail in the video below.

Running style

The research has shown that changing your running style to giving lighter, quicker steps can work well to treat ITB syndrome. Increasing your cadence (how many steps you give in a minute) by as little as 5% can significantly reduce the impact forces on your body when you run.


Try this:

  1. Get your cadence. Most running watches these days tell you your cadence, but you could also just count how many steps you give in 1 minute when you’re running at your preferred speed.

  2. Download a metronome app to your phone and set it to 5% quicker than your current cadence. For example: If your current step rate or cadence is 160 steps per minute, set the metronome to 168 (5% of 160 = 8) beats per minute.

  3. Go out for your normal training runs and try to do 1 or 2 minutes sections at this new cadence. You won’t be able to do a full run at this new rhythm immediately but keep practising.

Orthotics

You may benefit from wearing some orthotics if you have one leg shorter than the other or your feet roll in too much (over-pronate) when you run. I would consult a podiatrist if you have a leg length difference, but below are some affiliate links to orthotics on Amazon that may help correct over-pronation.

ITB straps/braces

Some of my patients have found using ITB straps or braces helped them. They work by changing how the ITB makes contact with the bone. For some people this can off-load the painful part and allow them to train pain free.


Are you causing more damage by using them? I usually advise people to see how they feel within the next 24 hours. If, when using the ITB support, they are pain free during their run and their symptoms are no worse during the 24 hours after the run, they are very likely OK to use it. If, however, they find that their pain is worse after their run or the next morning, I would say that they are better off not using the support. Let me know if I’m not explaining this properly and it doesn’t make sense!


Below are some affiliate links to examples of ITB braces/straps on Amazon.

In summary: Every person’s case of ITB syndrome will have a unique set of factors that caused it and your treatment plan needs to address all them. Let me know if you need any help with this. I can assess you using Skype video call and provide you with a treatment plan that is tailor made for you.

Best wishes

Maryke

About the Author

Maryke Louw is a chartered physiotherapist with more than 15 years' experience and a Masters Degree in Sports Injury Management. You can read more about her here.

Follow her on LinkedIn or ReasearchGate


References

  1. Aderem J, Louw QA. Biomechanical risk factors associated with iliotibial band syndrome in runners: a systematic review. BMC musculoskeletal disorders 2015;16(1):356.

  2. Allen DJ. Treatment of distal iliotibial band syndrome in a long distance runner with gait re‐training emphasizing step rate manipulation. International journal of sports physical therapy 2014;9(2):222.

  3. Dodelin D, Tourny C, Menez C, et al. Reduction of Foot Overpronation to Improve Iliotibial Band Syndrome in Runners: A Case Series. Clin Res Foot Ankle 2018;6(272):2.

  4. Louw, Maryke, and Clare Deary. "The biomechanical variables involved in the aetiology of iliotibial band syndrome in distance runners–A systematic review of the literature." Physical Therapy in sport 15.1 (2014): 64-75.

  5. Phinyomark A, Osis S, Hettinga B, et al. Gender differences in gait kinematics in runners with iliotibial band syndrome. Scandinavian journal of medicine & science in sports 2015;25(6):744-53.

  6. Van der Worp MP, van der Horst N, de Wijer A, et al. Iliotibial band syndrome in runners. Sports Med 2012;42(11):969-92.

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