Running with IT band syndrome, is it OK and how does it fit in with treatment?

As with most injuries, there is no one-size-fits-all approach that applies to everyone when it comes to running with IT band syndrome. In this article, we'll share some tips on how you can decide whether it is OK for you to continue running and when it might be better to stop and concentrate on rehab first. We also discuss some common running style factors that may predispose you to developing IT band pain and how you can fix it. Remember, if you need more help with an injury, you're welcome to consult one of our physios online via video call.

In this article:

1. Can you run with IT band syndrome?

2. Don’t lie to yourself

3. Running style factors that may cause IT band syndrome

4. How can you improve your running style?

5. If you’ve had time off running, implement a run-walk programme

6. How we can help

We also made a video about this:

Can you run with IT band syndrome?

Yes, some people can continue to run while they have IT band syndrome, but others can’t or shouldn’t. Let me explain how you can tell what is right for you.

When deciding if you can continue to run with IT band syndrome or not, there are two questions to consider:

1. What happens to your pain while you’re running (immediate pain response)?

2. What happens to your pain in the 24 hours after the run (24 hour pain response)?

When might it be OK to continue running

• If your pain starts only after a few kilometres into your run, AND

• the discomfort never increases above a slight discomfort while you’re running, AND

• the discomfort settles back down within an hour or two after you’ve completed the run,

then it may be OK to continue running while you undergo treatment for your IT band syndrome.

I would still suggest that you try and limit/reduce your running distance to whatever you can do pain free.

When might it be better not to run?

• If your pain starts quite early on into the run, OR

• You notice that it is starting a bit earlier into each run, OR

• it increases dramatically during the run, OR

• regardless of how much it hurts during the run (even if it is pain free), it causes your knee to hurt significantly more for the next 24 hours after your run,

then it may be best to stop running and first focus on your rehab.

Don’t lie to yourself

I know, it’s really hard to stop running. But I want to urge you not to lie to yourself when answering the above questions. If you get any indication that your knee is more sensitive this week compared to last week, or you’re just not making progress with your rehab, rather stop running. IT band syndrome responds really well to an exercise-based treatment plan and most patients will be able to ease back into running within 6 weeks.

Running style factors that may cause IT band syndrome

There are some characteristics in your running style that may predispose you to developing IT band syndrome. These include if you run with:

• Excessive pelvic drop;

• Excessive internal (inward) rotation of the leg;

• Excessive adduction of the leg (where the leg crosses over to the mid-line).

All of these are part of the normal running gait cycle. It is only when it is excessive that it may cause your IT band to pull too tight and get injured. This is why it’s good to have it assessed, otherwise you may waste your time trying to fix something that doesn’t need fixing.

How can you improve your running style?

Increase your cadence

Increasing your cadence (how many steps you take in a minute) by as little as 5% can significantly reduce the impact forces on your body when you run. This in turn has been shown to reduce the amount of pelvic drop and internal rotation of your leg.

Cadence drill

1. Get your cadence. Most running watches these days tell you your cadence, but you could also just count how many steps you take 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 minute sessions at this new cadence. You won’t be able to do a full run at this new rhythm immediately, as it will feel like quite a hard effort, but keep practicing.

Widen your stride

If you find that you run with a cross over pattern (like you’re running on a tight rope), widen your stride a bit. How do you know if this is what you do? Signs that your legs are crossing over too far to the mid-line are:

• If you kick your ankles, or

• When filmed from behind, you can’t see a gap between your thighs.

If you’ve had time off running, implement a run-walk programme

A run-walk programme is where you alternate between short periods of running and walking. By adding in walks, you ensure that your IT band is never pushed to its limit. It has two benefits:

1. It ensures that your body gets used to running again without reinjuring, and

2. It is perfect for teaching yourself an improved running technique (if needed).

Your physiotherapist will be able to advise you on what the best run-walk programme is for you. You can read more about the treatments for IT band syndrome in this article.

How we can help

Need more help with your injury? You’re welcome to consult one of the team at SIP online via video call for an assessment of your injury and a tailored treatment plan.

We're all UK Chartered Physiotherapists with Master’s Degrees related to Sports & Exercise Medicine. But at Sports Injury Physio we don't just value qualifications; all of us also have a wealth of experience working with athletes across a broad variety of sports, ranging from recreationally active people to professional athletes. You can meet the team here.

About the Author

Maryke Louw is a chartered physiotherapist with more than 15 years' experience and a Master’s Degree in Sports Injury Management. Follow her on LinkedIn and ResearchGate.

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. Balachandar, V., et al. (2019). "Iliotibial Band Friction Syndrome: A Systematic Review and Meta-analysis to evaluate lower-limb biomechanics and conservative treatment." Muscles, Ligaments & Tendons Journal (MLTJ) 9(2).

4. Barton, C. J., et al. (2016). "Running retraining to treat lower limb injuries: a mixed-methods study of current evidence synthesised with expert opinion." British Journal of Sports Medicine 50(9): 513-526.

5. 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.

6. Friede, M. C., et al. (2021). "Conservative treatment of iliotibial band syndrome in runners: Are we targeting the right goals?" Physical Therapy in Sport.

7. McKay, J., et al. (2020). "Iliotibial band syndrome rehabilitation in female runners: a pilot randomized study." Journal of Orthopaedic Surgery and Research 15(1): 188.

8. 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.

9. 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.

10. 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.