Question 1

Overview of the IT band

Accepted Answer

Iliotibial band (IT band) syndrome is the most common cause of outer knee pain in runners. The iliotibial band is a thick band of fascia (tough, sinewy tissue) that runs along the outside of your thigh. It starts at the top of your pelvic bone and attaches to the outer side of your lower leg, just below your knee joint.IT band syndrome is an overuse injury that most commonly develops due to a sudden increase in running volume, frequency, or intensity.

Question 2

Symptoms of IT band syndrome

Accepted Answer

IT band syndrome pain is located over the outer side of the knee. It can be a sharp, achy, or burning pain. You will usually be able to reproduce your pain by pressing on the area.
You may notice a bit of swelling and puffiness along the outside of your knee.
You will only feel the pain during exercise or when you move, not at rest.
IT band syndrome is an overuse injury that develops gradually during exercise and not due to sudden traumatic events, such as twisting your knee.
The pain usually starts after you’ve run a certain amount and worsens as you continue running on it.
Long runs, downhill running, or running on a camber aggravate it most.
Common everyday activities that may hurt when you have IT band syndrome include walking down stairs or squatting down to the floor.

Question 3

When to see a doctor

Accepted Answer

You should consult your doctor or physical therapist before using the app to ensure you have the correct diagnosis and are ready to start rehab exercises. If you have any concerns about your injury after you've started your rehab, schedule a review with your doctor, particularly if:

You feel a sudden sharp pain in your knee while doing an activity - it may mean you've strained or torn something, and the program in the app may no longer be appropriate for you
Any part of your leg (thigh, calf, or foot) is swollen, red, hot to touch, or throbs with pain - these signs can indicate a blood clot, which should be investigated as soon as possible
You have pain at night that keeps you awake or interrupts your sleep
You feel pins and needles or tingling in your leg - this can mean you’ve injured a nerve and our rehab plan may not suit you
Your symptoms get worse
Your injury does not recover as expected (see expected recovery times below)

Question 4

Causes of IT band syndrome

Accepted Answer

Interestingly, research shows that in most IT band syndrome cases, it's not the IT band itself that becomes injured. Instead, the fat pad between the IT band and the bone becomes inflamed and painful.

The fat pad's role in this area is to protect the IT band as it compresses against the bones. But when there is excessive compression, the fat pad can be injured.

Experts theorize that the lower portion of the IT band can be excessively compressed in runners if their knee turns in excessively, or their hip adducts (move inward) excessively when they run. According to research, there’s no clear cause for IT band syndrome and several factors likely combine to cause the condition. Some of the most common risk factors for developing IT band syndrome include:

Running on a camber
Doing lots of downhill running
Weak gluteal muscles, causing your leg to adduct and turn in excessively
Excessive pronation at your foot or ankle, causing your knee to turn in excessively
Shoes that are too flexible, encouraging excessive pronation
Fatigue - when you push into fatigue, your muscles aren't able to control your legs properly - this can happen during a single hard running session or when you train on tired legs (due to not allowing full recovery between training sessions)

Clinicians initially thought that an overly tight IT band caused the injury because your IT band and leg muscles generally feel very tight when you have it. But now we know that the IT band itself can't contract, stretch, or become tight on its own. Rather, the muscles that attach to the IT band (glutes, tensor fasciae latae, outer quads) pull it taut when they contract.

Question 5

Rehab, recovery times & prevention

Accepted Answer

Rehab

According to research, the current advice is that rehab for IT band syndrome should consist of 3 parts.

1 - Initial pain and inflammation management to calm down the injured area. Treatment options that may help with this include:

Avoiding aggravating activities: This includes stopping running or significantly reducing your running volume for a while; the app contains articles explaining how to decide what activities are OK to continue and gives suggestions for keeping fit while recovering
Taking anti-inflammatory medications (NSAIDs): A doctor should prescribe these for you
Icing or cooling the injured area: The app provides detailed advice on using ice to decrease pain and inflammation
Massaging or foam rolling the muscles attaching to the IT band: This can help reduce tension and pain, but be sure to avoid the injured area next to your knee; and refrain from using strong pressure, as it can make your injury feel worse
Wearing supportive insoles: Runners who pronate excessively at their feet or ankles may benefit from using insoles - a podiatrist can assess if they will help you
Using IT band straps or braces: There's currently no research showing these devices work
Avoiding corticosteroid injections: Research shows they can reduce pain in the short term but may have detrimental effects on long-term recovery

2 - Rehab exercises (such as those in the app) to help with injury recovery and prevention. The exercises should start at a low intensity and gradually progress, finally restoring the strength you require for running. Types of exercises include those aimed at:

Improving strength and control in the muscles that may have contributed to your injury (core, hips, ankles)
Slowly restoring the strength of the injured tissue
Stretching to reduce the tension in the muscles attached to the IT band

3 - A slow return to running, including adapting your running style to reduce the strain on your IT band. The app provides information on how to assess your running style, what risk factors to look out for, and how you can improve it.

Recovery times

Most cases of IT band syndrome recover within 6 to 12 weeks, but sometimes it can take longer. Your recovery time will depend on:

The severity of your specific case
How quickly you start the correct rehab plan
Your body's ability to heal

Prevention

You can reduce your risk of developing IT band syndrome by:

Avoiding sudden increases in training volume and intensity
Varying your running surface and terrain
Choosing running shoes that provide the appropriate level of support you need
Maintaining a good baseline level of strength and flexibility in your body

Question 6

Research References

Accepted Answer

Aderem J, Louw QA. Biomechanical risk factors associated with iliotibial band syndrome in runners: a systematic review. BMC Musculoskeletal Disorders 2015;16(1):356.
Alexander JLN, Culvenor AG, Johnston RRT, et al Strategies to prevent and manage running-related knee injuries: a systematic review of randomised controlled trials British Journal of Sports Medicine Published Online First: 23 September 2022. doi: 10.1136/bjsports-2022-105553
Allen, D. J. (2014). "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 9(2): 222.
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).
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.
Besomi Molina, Manuela. "Towards the investigation of the tensor fascia lata muscle and iliotibial band function in runners: the relevance of the why and the how." (2021).
Brukner P, Clarsen B, Cook J, Cools A, Crossley K, Hutchinson M, McCrory P, Bahr R, Khan K. eds. Brukner & Khan’s Clinical Sports Medicine: Injuries, Volume 1, 5e. McGraw Hill; 2017. Chapter 37 - Lateral Medial Posterior Knee pain
Dodelin, D., et al. (2018). "Reduction of Foot Overpronation to Improve Iliotibial Band Syndrome in Runners: A Case Series." Clin Res Foot Ankle 6(272): 2.
Friede, M. C., et al. (2021). "Conservative treatment of iliotibial band syndrome in runners: Are we targeting the right goals?" Physical Therapy in Sport.
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.
Miccio, S., et al. "Conservative Rehabilitation Treatments of Iliotibial Band Syndrome: A Systematic Review." Muscles, Ligaments & Tendons Journal (MLTJ) 11.1 (2021).
Narducci, Dusty Marie, et al. "Is There a Correlation Between Reported Knee Pain and Fluid at the Distal Insertion of the Iliotibial Band in Runners?." Cureus 14.8 (2022).
Robertz, Leon, et al. "EFFECT OF DOWNHILL RUNNING ON BIOMECHANICAL RISK FACTORS ASSOCIATED WITH ILIOTIBIAL BAND SYNDROME." ISBS Proceedings Archive 40.1 (2022): 595.
Willwacher, S., Kurz, M., Robbin, J., Thelen, M., Hamill, J., Kelly, L., & Mai, P. (2022). Running-Related Biomechanical Risk Factors for Overuse Injuries in Distance Runners: A Systematic Review Considering Injury Specificity and the Potentials for Future Research. Sports Medicine, 1-15.

Strong Knees: Lateral Stability