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Preventing and Treating Iliotibial Band Pain

Published December 24th, 2018

My focus on building and maintaining good health started early. I started running track in my teens, initially only because a close classmate was a runner, but I quickly fell in love with the way it shaped my body and improved my mental health. I loved the way it challenged me, especially as a 16-year-old kid. Later, I even went on to run marathons, something I never could have imagined would’ve been a possibility back when I was just testing the waters with my friend at track meets. However, before I ever got to the point of being ready for marathons, I had to learn to respect my body.

I was in my first semester of college, successfully running track for a couple of years, when I was struck by one of the worst pains I’d ever experienced. It felt like I was being stabbed in my knee and upper leg, while my hip throbbed. I wasn’t even running a long distance -- just a quick few miles with the rest of my college track group -- when it suddenly felt like my knee just wouldn’t let me run anymore. I basically collapsed to the ground mid-run, overwhelmed by the sudden intensity of the pain. I was horrified, embarrassed, and afraid that I’d somehow managed to completely derail my running future without even knowing what I’d done. My track teammates and coach had to help me back to my dorm, before taking me to a local orthopedic urgent care center that was luckily near the campus.

That was my first experience with iliotibial band syndrome.

What is Iliotibial Band Syndrome?

It helps, first, to know what the IT band is. I certainly didn’t when the doctor told me what I’d done. The IT band isn’t something we hear much about, but scientists think it plays an important role in either locomotion or stability.1  The iliotibial band is a thick band of connective tissue, called fascia in medical circles, that runs down your thigh to the bone of your shin. In fact, it’s actually the largest of this type of tissue in our bodies.1

When you have iliotibial band syndrome, your IT band has become too tight, causing friction — which causes swelling of the IT band, inflammation, and pain. Your body actually has a built-in mechanism for preventing this painful friction — a fluid-filled sac called a bursa that allows the IT band to glide over your knee as you move 2 — but many different things that we do as runners can prevent that sac from doing its job, and instead swell up along with the IT band. Yes, ouch.
The pain is most often felt just like mine was, in a stabbing or aching sensation right outside of the knee, making you think that the pain is actually coming from something wrong with your knee, rather than a band of connective tissue traveling down your upper leg. It doesn’t help the confusion that your knee can swell up, too, and you can also sometimes feel pain in your hip and thigh, like I did.
Perhaps the worst thing about IT band syndrome is that once you get it, you can have a difficult time getting rid of it completely. Iliotibial band syndrome isn’t always treated correctly, and even when it is, recurrences aren’t uncommon, especially if you don’t change the habits that led to iliotibial band syndrome in the first place.  

What Causes Iliotibial Band Syndrome?

As runners, we definitely like to test our limits. We don’t always heed the warnings about the importance of stretching or building up to the miles we run. I know I didn’t. During the summer gap that I had between high school and college, I got a bit lazy. I didn’t keep up with the running schedule that I’d had in high school for those 2 months, and then when college came along, I raced right back into running as though I were still fully trained. That’s what caused my IT band syndrome —doing too much way, way too soon.
Doing too much before your body is ready is one of the causes of IT band syndrome, as is overuse. Yes, as hard as it is to believe, we really can just run too many miles without enough rest in between for our IT bands. There are also certain ways that we run, like running downhill or on the typical banked surfaces of tracks, that can trigger an iliotibial band incident. Even wearing worn-out shoes can throw off our stability enough to irritate our IT bands.2

So, How Can We Prevent Iliotibial Band Syndrome?

Clearly, one of the biggest ways that we can prevent iliotibial band syndrome is by trying our best to use proper running techniques. I know we want to literally hit the ground running, but we have to remember that all of those precautions we’re told about exist for a reason. As runners, we have to stretch, warm-up, and cool down properly during each running routine.2
We also have to remember the importance of rest and recovery. Create a schedule that alternates high mileage days with low mileage days and rest days. Build up your stamina and train for big events, like marathons, correctly, with plenty of recovery time. Listen to your body! Don’t try to run through pain in the hopes of making that perfect time. Remember that running through pain is only going to make you less likely to hit your dream time, as you continue to aggravate the IT band further and further.
You might also want to try spending most of your time running on flat, rather than banked, surfaces, and don’t forget to replace your running shoes when you notice they’re beginning to wear down.2 Think of it this way: If your running shoes are wearing down, your IT band probably is, too!


The Prevention Didn’t Work. Now What?

Iliotibial band syndrome can affect anyone at any point in their running lives, so don’t feel bad. The important thing is to completely treat the injury, and that first treatment is usually immediate rest.3 That’s right. Unfortunately, for the time being, you have to stop running. If you try to keep running, you risk creating a kind of permanent iliotibial band syndrome that will always irritate you when you run.

When you first notice symptoms, it’s a good idea to visit your primary care physician or orthopedic doctor for an exam. Your doctor will evaluate your knee, and may order additional tests if needed, like an MRI. 3
Of course, just because you’re not running doesn’t mean you should spend your days on the couch. Remaining active will keep you in top physical condition while your body heals. Some of the best types of exercises you can do while your IT band recovers are water sports, like swimming or water aerobics. These kinds of sports are gentle on your joints, good for your mental health, and keep your body well-conditioned.
You’ll also benefit from the traditional ice pack and heating pad treatments. For particularly severe cases, there are certain other things that your doctor can discuss with you that might help to ease the pain and move healing along, like electrical stimulation with cortisone and cortisone injections.3 Of course, like any treatment, these may come with risks alongside their benefits.
Luckily, for most athletes, proper rest, heat, and ice are enough to help the iliotibial band recover. However, sadly, this recovery process can take a few weeks, and requires patience.

More Tips: Stretches, Massages, and Omega 3s

If you have IT band syndrome, believe me, I know how anxious you are to run again. While you wait, there are some additional things you can do to help speed the process along.
Your doctor can likely give you a list of the many specific stretches that are helpful for the IT band. You’ll also want to regularly massage, even after your recovery from iliotibial band syndrome. There are a variety of self-massage tools you can purchase online, and there’s something for every budget, from a high-powered massager to a simple ball that you roll across the area.4
Of course, omega-3s seriously come in handy when it comes to treating and preventing iliotibial band syndrome. Omega-3s reduce inflammation and pain, both strong features of ITB, so increasing your intake of foods rich in omega-3s, like walnuts and oily fish, is definitely recommended. That being said, as athletes, we likely won’t be able to get all of the omega-3s we really need from food alone. The general, non-running population usually doesn’t even get enough omega-3s!
This is where our supplement reviews can help you out. Browse through our rankings, and select a supplement to support you during your recovery, as well as when you begin running again.
While I don’t want to push my personal supplement choices onto you, when it comes to recommending supplements to my fellow athletes, I have to mention my beloved Omega XL. The omega-3s in Omega XL come from the green-lipped mussel of New Zealand, and this particular oil has been associated with not only the reduced inflammation and pain of traditional fish oils, but increased lung capacity for runners, as well, making it an ideal supplement for athletes.

Listen to Your Body

Listening to and caring for our bodies is what is going to make us better runners. We can’t run through pain, overuse our muscles, or forget about seemingly little things, like worn-out shoes and unstable track grounds. The last thing you want is chronic iliotibial band syndrome,  a result of not healing the IT band properly.
It took my a full month to recover from my iliotibial band syndrome, and I still get flare-ups from time to time. When I do, I immediately stop, rest, and apply heat, ice, or massage. I start every run with stretches and warm-ups now, even when my fellow runners don’t, and I hold tightly to my bottle of Omega XL. I don’t ever want to be unable to be run for that long again!