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Your IT Band SHOULD be Tight!

Iliotibial Band (ITB) syndrome is the most common cause of outer knee pain in runners. Despite the unfortunate popularity of this debilitating syndrome, there is a plethora of outdated information on the cause and its ultimate treatment. I want to start by addressing the biggest rehab fallacy regarding this topic: The ITB is too tight and needs to be stretched.

Your Iliotibial Band SHOULD be TIGHT! 

This fact goes hand in hand with the ITB’s primary function as a propulsion mechanism for forward movement. The dense fibrous connective tissue that makes up the ITB is instrumental in the storage and release of force to propel us forward while running. Think of it as a natural super shoe built into the body. It has both a cushioning component like foam to absorb force and has rigidity like a carbon fiber plate to provide spring.

Further studies show there is NO difference between the ITB tightness from runners experiencing ITB syndrome and runners without. In fact, those undergoing successful physical therapy actually INCREASED their ITB tightness over the course of treatment. The IT Band must be strong and tight to handle the forces associated with running.  

So what is actually going on when you have IT Band pain? 

Evidence demonstrates the issue is most likely a chronic compression injury. The ITB attaches along the thigh bone, outer knee cap, and on the outer shin bone. Previously, the cause of the pain was thought to be due to friction when the ITB moves over the bony areas of the outer knee. This painful range from 20-35 degrees of knee bend is a common complaint with the syndrome. The problem with this outdated theory is that the ITB is not highly innervated and therefore does a poor job of sensing pain. 

What is highly innervated and therefore sensitive to pain is the adipose tissue beneath the ITB. This supports the compression model - the ITB is overloaded and compresses against the sensitive tissue beneath it. So, when runners painfully foam roll the “ITB” not only are you having no impact on lengthening the dense fibrous tissue and correcting the problem but you could actually be further exacerbating pain and prolonging recovery.

Why did this problem come on?

Iliotibial Band Syndrome is typically a training load error. The ITB stores and releases energy, so a significant increase in loading to this force absorption mechanism creates the problem. The primary culprits are increases in running intensity, total running volume, and/ or more time spent on trails and downhill running. The literature has handily dispelled previous theories that anatomical factors such as foot pronation, female hip width, running gait mechanics, or gluteal strength are direct causes. 

ITB Syndrome causes Glute Weakness

Glute weakness is often present in runners with ITB Syndrome BUT the driving force behind this glute weakness is typically actually the pain from inhibiting the muscle, rather than glute weakness causing the pain.

Glute strengthening is helpful to improve hip stability and prevent excess hip drop while running. Hip drop is important because it can further load an already irritable ITB which can decrease running tolerance. Similarly, improving stride width and cadence has also been shown to reduce ITB strain and therefore provide the tissue with the opportunity to recover. Addressing these biomechanical issues is a temporary but often helpful tweak to improve running tolerance during advanced phases of treatment. It is important to understand these biomechanical factors are not why ITB syndrome developed and are not paramount for long term success. 

How do I manage IT Band Pain?

The operative word here is management. It is important to continue running or cross training to a tolerable level. Modifying the irritable loads to the ITB is crucial to its recovery and progression back to desired levels of running. This is going to be unique to the individual. Remember, the ITB is designed to absorb and transmit force and will require an incremental force loading program to truly rehab the tissue. Rehabilitation stages should progress from heavy strengthening to plyometrics and eventually increase running intensity and duration. The greater the intensity and/or volume, the longer the process may be. Setbacks are very common as it is challenging to know when your load tolerance has improved. Recognizing the reason for the setback and how you adjust your plan are key to solving this issue for good!

 Below is Steady State’s 3 step process to treating IT Band related pain:

  • Step 1 - Restore, not rest
    • Find a tolerable activity level that minimizes symptoms
    • Begin loading in a graded manner that does not aggravate symptoms
  • Step 2 -  Reload to 100%
    • Progress to include heavy strengthening and plyometrics
    • Build running back to desired levels
  • Step 3 - Optimize for longevity
    • Build beyond prior levels of strength to decrease your likelihood of a recurrence of symptoms. 

If you or a friend are struggling with IT Band Syndrome, we can help! Contact us at to set up a free 20-minute discovery call to get started.