On this page 4 sections
Your guide
What you'll learn
Have you recently started a new walking, running, or exercise program and felt a sharp, burning pain on the outside of your knee? Maybe you’ve just had surgery on your knee or a total knee replacement and you feel this same pain sensation. What you could be experiencing is something called IT Band Syndrome. In this article we will explore what IT Band Syndrome is, and the best exercises to help with the pain that this condition can cause! We will have you back in your running shoes in no time!
Anatomy Review: What is the IT Band?
The IT (or iliotibial) band is often mislabeled as a muscle in our body when in fact, it is a long piece of fibrous, anchoring connective tissue that runs from the outside of our hip to the outside (or lateral) part of our knee. At the hip, it connects to our TFL (tensor fascia latae) muscle which assists with hip internal rotation, flexion, and abduction. It runs down to connect at the outside of our kneecap to help with stabilization during activity, especially high impact high-impact ones such as running or laterally cutting with certain sports or sport-specific drills.
The IT band itself is made up of mostly connective tissue and thick collagen, making it very strong and able to absorb a lot of shock force for the lower extremities. This is especially important for high demand activities such as sports and running for knee and joint injury protection. There is also a small amount of elastin fibers woven into the IT band structure which allows it some pliability (think like a spring!). However, this does not give it the ability to stretch like a muscle would, which will help us when we think about how to treat IT Band Syndrome. Learn more about what roll foam rolling and stretching can play in rehab for IT Band Syndrome in the video below!
What causes IT Band Syndrome?
IT Band Syndrome is usually diagnosed as an “overuse injury” and is most commonly seen after a person starts to become more active and starts to place more demand on the IT band and the knees. These are the folks who come into our PT clinic stating that they are so proud of themselves for starting a new walking or running program, but they’ve got this nagging lateral knee pain that just won’t quit! Sound like you? Keep reading to see what exercises to do!
IT Band Syndrome is also very common in athletes, especially those sports that involve repetitive flexion and extension of the knee. Some examples of this can be rowing, soccer, basketball, and field hockey. Due to overuse and the “sliding back and forth” action of the fibrous tissue, the attachment of the IT band to the knee gets very overworked and inflamed, causing lots of pain!
IT Band Syndrome pain can feel like:
- Burning at the outside of the knee
- Pain at the outside of the knee that increases with activity and calms down when the activity stops
- Clicking, popping, or snapping sensation at the outside of the knee
- Feelings of “instability” at the knee
READ: IS CRACKING JOINTS BAD? THE SCIENCE OF JOINT CAVITATIONS
Various factors put a person more at risk for IT Band Syndrome. Some of these factors include:
- Anatomy: the orientation and alignment of the hip and knee can cause over-rotation of the foot and lead to IT band friction and pain
- Flexibility: lack of muscular flexibility in the quads, hamstrings, or hip musculature can cause the joints to have to compensate for this and be painful
- Muscle strength: imbalances in muscular strength and power between the hip and knee musculature can lead to abnormal forces pulling on the IT band
- Training surfaces: training on hard, flat surfaces in one direction repeatedly can cause overuse and strain on the IT band
- Shoe wear: training in improper or nonsupportive footwear can lead to altered lower extremity mechanics and stress on the IT band
LISTEN: HOW DO YOU PICK THE RIGHT RUNNING SHOES?
- Training dosage: overtraining or excessive training time can lead to IT band stress and pain - this is more often than not the main culprit for that nagging IT band pain. Doing too much of something too soon and placing that tissue through a load it wasn't ready to handle.
How do I start to rehab IT Band Syndrome?
Because IT Band Syndrome is considered an overuse syndrome, in the initial stages your doctor or physical therapist may advise resting from the activity that is aggravating the injury, or at least decrease the volume and intensity of the activity. You may be advised to “stretch” or “foam roll” the IT band area, HOWEVER - remember our anatomy discussion from earlier - the IT band is NOT a muscle and therefore cannot be “stretched” the way a muscle normally would! Foam rolling or stretching in the early phases of rehab can provide some benefit to alter the sensation pathway going to our brain to say “Hey brain, here’s something that feels good - now calm down!” To learn about what is happening when you foam roll, dive into the podcast below!
LISTEN: SHOULD YOU BE FOAM ROLLING? WHAT DOES FOAM ROLLING ACTUALLY DO?
But, in order to mCross-Connectake a difference in our pain in the IT band, we look to what kind of load we are placing on not just the IT band, but the surrounding musculature that helps to support it. Because we are becoming more active or playing sports, therefore demanding load from the IT band, we must help to support that load in the lower extremities by strengthening the musculature surrounding it. These muscle groups include the quads, hamstrings, hip rotators, and gluteal muscles. By performing strengthening in these areas, we will have a more balanced load capacity of the leg, and therefore have less pain!
What exercises are helpful when I am ready to strengthen? Take a peek below to find out!
Exercise 01 of 04
Exercise demonstration
Isometric Cross Connect Bridge
View exercise instructions
- HOW: Begin by lying on your back with knees bent, feet flat on the floor. Take the knee of one leg towards the chest and the elbow of the opposite side arm towards the feet. Using a ball or yoga block, connect the elbow and the knee for a static hold. Driving through the heel of the foot on the floor, push your hips up towards the ceiling. Hold for duration.
- FEEL: You should feel your front and side abdominals. You should feel the front of the hip that driving up towards your chest. . You should feel the back of the hip, including the hamstring and gluteal muscles, that is the bridge motion.
- COMPENSATION: Avoid letting the shin sag down on the leg side performing the cross connect. Avoid any strain in the neck, option to rest the head. Avoid arching your low back when in the bridge position.
The above is a good exercise to work on core control while also working on pure hip extension. Remember that the IT band can give us some grief when the muscles surrounding the tissue aren't as strong as they should be. Getting those glute muscles strong is key!
Exercise 02 of 04
Exercise demonstration
Bulgarian Split Squat- Dumbbell
View exercise instructions
Let's not forget the attachment that the IT band has to the TFL muscle which plays a role in hip flexion, so work those hip flexors!
Exercise 03 of 04
Exercise demonstration
Half Kneeling Hip Flexor Lift Off
View exercise instructions
- HOW: Begin in a half-kneeling position. There should be a 90 degree bend in both the front and back knee. Option to use the arms to the side for added balance. With a light weight shift to the back leg, lift the knee of the front leg straight up to the ceiling. Hold for duration and slowly return to the starting position.
- FEEL: Will feel the front of the hip working. Also may feel the lower abdominals working.
- COMPENSATION: Avoid turning your hip inward or outward. Avoid bending or extending your knee. Option to use sticks for added balance.
Lastly, working on using the IT band as a means to use stored energy with those cutting type of movements with bounds as seen below!
Exercise 04 of 04
Exercise demonstration
Lateral Bound
View exercise instructions
- HOW: Shift your weight to one leg with your knee slightly bent and the other leg off of the ground. Slightly bend down and push into the ground, jump to the side landing on the opposite leg. Get your balance, pause, and jump back to the other leg going back into the starting position.
- FEEL: You will feel all the muscles in your legs working.
- COMPENSATION: Landing Position. Make sure your knees are aligned over your toes. They should not dive inwards on the landing. Your goal is to absorb as much of the landing forces as you can and land softly. That means that you want your hips and knees to bend as much as they need to, to absorb the force. If you do not let them bend much, you will land "stiff" and hard. Let your hips go back and while keeping your chest up to help absorb the forces. Your toes should touch the ground first when you land and quickly your heels will follow. You should land in a "ready position" like you would if you were playing sports, with your weight ever so slightly forward on the balls of your feet. You should not fall forward or backwards after landing.
- For a detailed video on landing mechanics on one leg, click here: https://www.youtube.com/watch?v=6RCOGM5tZRM
Closing Thoughts
IT Band Syndrome is very common among active people, and can be very annoying, nagging pain that threatens to derail our active lifestyle. We cannot allow this! And thankfully there are lots of exercises and tools to help us get back on track, as discussed in this article. Allowing some time to let the initial pain and inflammation calm down and following up with some of the suggested exercises under the supervision of your doctor or PT can help get you back to that activity that you love!
GET STARTED WITH OUR KNEE PREHAB PROGRAM
Taryn Beaumont, PT, DPT, CLT, CF-L1, CNC
[P]rehab Writer & Content Creator
Taryn was born and raised in Maine and still resides there with her fiancé and son. Taryn received her Doctorate in Physical Therapy from Husson University in 2010, and also carries a Bachelor's in Kinesiology and Human Movement Science. She is a Certified Lymphedema Therapist, a Certified Crossfit Level 2 Trainer, and a NASM Certified Nutrition Coach. Taryn has 12+ years of experience in many different realms of PT, from the young athlete to the geriatric patient. Most recently she is employed with a home health PT company and is working toward her Advanced Competency in Home Health. Taryn considers herself a ‘lifelong learner’. She has special interests in oncology care and breast health, dry needling, and Crossfit training. In her free time, Taryn enjoys fitness, spending time with her family, continuing education, writing, and reading, and is very excited to be a part of The [P]rehab team to educate and empower others to take control of their health and wellness.