Unraveling the Mystery of IT Band Syndrome: Myths, Truths, and the Best Shoes for IT Band Issues

Yes, it is the time of the year, when we start seeing dry pavement and start noticing our dusty road running shoes in the corner of the garage. Or – even better – we open that crisp new shoe box and Voila! – a new pair of running shoes. We take them for a spin, and with the wind and sunshine hitting our faces, we keep going.. and keep going, feeling great! Then, the next morning you can barely get out of bed, barely squat down to pick up the dog dish from the floor or go up or down stairs. Your knee is KILLING YOU!!

Seriously, we’ve all done it. Now you are thinking ‘I have iliotibial band (ITB) syndrome!!’o, what is it and why is it so tweaky? What can you do to get it better? Should you run through the pain? What about shoes? All these questions start popping up in your mind.

Over the years, I have seen many athletes come to the clinic with ITB issues. Some of them acute (it just happened), but many of them had ITB issues for many months or years!
When we look into the anatomy of the iliotibial band, you can see it consists of a tough tissue (fascia) that runs along the outside of your thigh, from just above the hip (via tensor fascia lata and gluteus maximus muscles) to just below the knee. It is made up of elastic connective tissue found throughout the body. There is a reason why the IT band is so tough – it can withstand large loads. It acts like a spring mechanism when you are running, stabilizing your knee and your hip. The insertion at the knee is the weak part and many times, it gets irritated. But -nothing in our body happens in isolation! Often, what you see (or what gets injured in overuse injuries), is a compensation for a problem somewhere else!

So what happens when I feel pain in the ITB?
Many think that ITB issues happen because the iliotibial band is ‘tight’. Well, it has to be tight, because it stabilizes the knee and the hip! The problem happens when there is too much friction between the ITB and lateral femoral condyle (a bony prominence at the outside of the knee). The tissue in this area can be VERY sensitive to friction. Have you ever noticed swelling at the outside of the knee? Yes, that can be a bursa or a fad pad under the ITB that got irritated. So contrary to the views that we believed 10+ years ago, the ITB syndrome is more likely a compression issue than a tension issue. ​

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What are the factors that may make you more prone to ITB Syndrome?

1. Muscular imbalance
, especially hip flexors, hip adductors, gluteus medius and hip external rotators. Weak hip flexors can increase the forces the ITB has to withstand. Tensor fascia lata muscle also acts as a hip flexor – and it takes over when the iliopsoas is weak. Remember the phrase ‘what you see is just a compensation for a problem somewhere else?’ If your tensor fascial lata becomes overactive, it becomes hypertonic (feels tight) and painful. It sits in ‘the front pocket of your pants’ and you can easily find it. THAT is the place to foam roll, if you are inclined to do so.

2.Biomechanical imbalances
 at the hip, knee and foot/ankle. A big factor is dynamic knee valgus – when your knee moves inwards when you land on single leg. This may be due to muscular imbalances at the hip but also at the foot and ankle. Another biomechanical factor is contralateral pelvic drop – when you drop your hip on the stance leg, then the whole lower chain tends to collapse inward. If you are dealing with ITB issues, have a running specialist evaluate your running gait and make suggestions.

3. Running Shoes?
 There is no direct correlation between running shoes, foot orthoses and increased or decreased risk of ITB syndrome. I have seen several runners with ITB issues that were OVERCORRECTED with high arch support. That stresses the insertion of the ITB at the knee. However, shoes worn past their running age may also contribute to biomechanical issues, which in turn stress the ITB. Shoes should be selected for comfort and to fit you and your running style, not your foot type and your injury history.

4. Training errors. Doing too much too soon, running hills before your body is able to adapt, inadequate rest and recovery, and running pattern that increases loads throughout the leg are just some of the errors I have frequently seen in the clinic. If you are new to running, or if you are returning to running after a period of inactivity, please consult a skilled professional (a physical therapist, strength and conditioning specialist or a running coach) to create a training plan that gradually progresses you towards your goals. And remember – you get stronger when you rest and recover from exercise!

Finally, some myths about IT Band
‘I need to foam roll to stretch or loosen up my IT band!’
Not really. Given that the ITB is made of tough, non-contractile fascia, it is impossible to foam roll it and expect it to lengthen or soften! So what does foam rolling do? In essence, it tends to desensitize the tissue so the become less painful. That is it. It does not change the biomechanics of the ITB!

‘I need to stretch my IT band to make it stop hurting’
How about stretching ITB? Again, you cannot stretch non-contractile tissue. By stretching the ITB, you are probably addressing the muscles at the hip. Good thing? Bad thing? The truth is that we don’t know.

Key take home messages:

  1. In regard to overuse injuries (like ITB syndrome), what you see is just a compensation for a problem somewhere else! Have your running/ walking biomechanics evaluated by a professional that specializes in running injuries and biomechanics (physical therapist).
  2. It is STRENGTH that is lacking, not length of the ITB! A skilled physical therapist can assess your movement and find muscle imbalances that are compromising the ITB function.
  3. Watch how much you do! Too much too soon, especially running downhill can irritate the ITB.
  4. Shoes! They can help but not cure. You should always fit a shoe to YOU and YOUR running style, not your pain issues.
  5. Foam rolling and stretching? Nah.. wont make much difference, unless you address the above.

Happy running! ​

​Do you want to learn more? Please contact us, we would be happy to answer all of your questions.
Helping recreational and elite Alaskan runners of all ages to return to running safely, effectively 
​and pain-free …for life.

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