You run a few steps and you’re in agony. You have pain on the outside of your knee. Not the hip, the side of the thigh or under the knee cap. The side of the knee. Lateral epicondyle for all you smart kids. Congratulations. You’ve just been diagnosed with IT band syndrome and no one really knows what to tell you. IT Band syndrome is, in the words of Winston Churchill:
‘A riddle, wrapped in a mystery, inside an enigma.’
He was referring to Russia. But if he’d had IT Band syndrome…
No one knows for sure what IT band syndrome is but there are some great guesses.
- IT Band friction syndrome- some think the pain comes from the band sliding and snapping over the side of the knee (lateral epicondyle) creating inflammation. This is challenged by recent findings that suggest the band is fixed and does not slide at all.
- Compression of fatty tissue under the band under- A recent study stated ‘that IT band syndrome is caused by increased compression of a highly vascularized and innervated layer of fat and loose connective tissue that separates the ITB from the epicondyle.’
- Tightness in your hips referring down- pulling the band out of place.
Most cases come from an intense, unfamiliar effort in running, hiking or walking. Your first long run, long hike etc. It’s always associated with a hard effort in your legs. Other contributing factors are increased speed, new terrain or new shoes.
My experience with IT Band syndrome
I’ve had it twice. Once I got it the day after running the Martha’s Vineyard 20 miler (unfamiliar distance at an unfamiliar (hard) speed). That was basically the second longest run of my life to that point and I PUSHED IT; Ran 5:50 pace for 20 (more like 5:40’s for 17 and then a slow miserable death for 3). Consequently I woke the next morning and couldn’t walk across the room.
What fixed it? Rest. Basically I took a month off from running and lifted weights. No repetitive stress on the knee and I got some compliments on my shoulders.
So there.
My second experience with IT band syhdrome was in the Disney Marathon. This was the second time I was running Disney. My heart just wasn’t into it. As a result my training was unfocused and forgettable. I got 22 miles into the race (where you jog onto the track at ESPN zone) and my right knee said enough. Ran onto the track, walked off it. I tried to do the old leg swing and foot hop thing but it just wasn’t happening. All in all a substitute par day.
What caused it? Not sure. I had done my long runs. I’m not a stranger to the distance. Like Churchill said, it’s a riddle. A mystery. An enigma.
What fixed it? Another round of unplanned Rest. Took a couple weeks off and then went for a test run. It was fine. Made me question whether or not I’d been hurt in the first place.
What did both races have in common? Chiefly I pushed myself hard off so/so base training. Life was busy. Too busy to pay close attention to weekly miles. I was winging it on talent and hoping for the best.
So, as shown above, rest gets two anecdotal votes from The Running Man.
What we know about IT band syndrome:
This is an overuse injury as shown above. It usually happens when increasing mileage. From my friends at Post physical Therapy:
IT band syndrome (ITBS) is a non-traumatic, overuse condition. It’s characterized by pain on the outside of the knee when the foot meets the ground during walking or running. The knee is usually slightly bent during when pain occurs. ITBS typically occurs in runners and cyclists due to the repetitive bending and straightening of the knee during these activities. After the initial onset of pain, people suffering ITBS might find it difficult or painful to walk, squat, climb stairs or increase lower body exercise intensity. Some may also notice an increase in swelling and tenderness to the touch on the outside of the knee. It is important to consult with a physical therapist to rule out any other possible problems that can have similar symptoms.
So my experience is consistent with your traditional IT band injury.
What should you do about your IT band injury?
An ounce of prevention beats a pound of cure. Be smart about increasing mileage. This is commonly brought on by a singular effort that you were unprepared for.
Treatment can be tricky. No good stretching it. You could hang a piano off your IT band it won’t stretch. You CAN stretch upstream and downstream of the band with some good results though. I recommend Figure 4 stretch, twisted triangle, and half pigeon.
Stretching rule #1: Don’t stretch a cold muscle. Warm up first.
Stretching rule #2: Don’t stretch a cold muscle. Why twice? Because I mean it.
And don’t foam roll it. You’ll just destabilize the band and that will make things worse. Seriously, don’t roll your IT band. I see it every day. I see trainers do it every day. I used to do it every day. Stop. This is the most common mistake I see in the gym day to day.
Your IT Band- You can’t stretch it. You can’t roll it. What are you supposed to do?
R.I.C.E. it. The main thing to do is rest and compress it.
Rest- I can vouch for this (as shown above).
Compression- I’ll get to that below.
Foam Roll- Not on it, but upstream. Roll out your piriformis, hip flexors, and TFL. Pain refers out. If stuck fascia and tissue are released then the IT band may function better. Click on the links to have a look at how to roll these spots.
Hopefully this works- but research has been inconclusive about the efficacy of foam rolling period. This clip explains why.
Some of you have rolled out and are still struggling. So now we’re going to break out the big guns.
Discliamer: None of what is outlined below can hurt you. I’m not a Doc, but I use this stuff all the time with amazing results. What I outline below may not fix you but it’ll get you moving better and WILL NOT HURT YOU.
So lets try some left field treatments on an injury that DEFINITELY lives in left field.
Left Field Solutions for IT Band syndrome
So lets think about pain for a moment. Your brain sends the pain signal. Why? Usually because there is tissue damage, but not always.
A Doc once performed MRI’s on the shoulders of 20 MLB Pitchers. 13 had shoulder pain and 7 did not. The results showed significant structural damage in 15 shoulders. Another 3 had enough damage to require surgery. Two two were fine.
So why did pitchers with structural damage have no pain?
The easy answer: no one knows. Pain, like your IT Band, is ‘A riddle, wrapped in a mystery, inside an enigma.’ Pain starts in the brain though. That I can state confidently. Everything is controlled by the brain. Even your IT band.
If ITB is caused by ‘compression of a highly vascularized and innervated layer of fat and loose connective tissue that separates the ITB from the epicondyle’ then two potential (and immediate) pain solutions present themselves.
First left field IT Band syndrome solution: Compression
And by compression I mean voodoo floss.
I repeat that no one knows exactly what causes ITB (beyond a hard effort your legs were unprepared for) but voodoo floss works by engaging fascia. And…
In short-Voodoo floss draws the attention of your brain to the flossed area. The fat layer is ‘highly vascularized and innervated’. The floss draws the brain’s attention to your knee. Meanwhile it constricts, then flushes blood through the fat layer.
Wrap your voodoo floss upward. Start below the knee, Wrap upwards. Once wrapped take the knee through a range of motion. Remove after no longer than a minute. Reassess your knee. You should feel a flushed, tingly sensation.
Second Left Field IT Band syndrome solution: Mirroring
‘Mimic performance, mirror pain.’ Straight from Z health. Mirroring basically means we work the opposite side of the body to improve range of motion and pain. Firstly, Start at the joint where you have pain. Second, Find the opposing joint. Finally, move it in the opposing direction. I’ve seen AMAZING changes here.
This works based on the fact that mirrored joints have similar bio-mechanical and neurological pathways. So moving the mirrored joint will clean up the pathways on the injured one. This is a consistent ‘WOW’ for clients.
Does it work every time? No.
How do you know it’s working? Assessments. Testing strength or joint ROM instantly indicates whether a drill works.
The opposing joint to your affected knee is your oppsite elbow. Therefore to Mirror knee pain we move our elbow through a number of drills. Here’s a link to show you how it’s done.
And since pain refers out lets move through some hip/shoulder mirroring to see if we can clean up thoseneuro and mechanical pathways.
To ascertain if mirroring works you have to test before and test after.
What do we test?
1- you can run, see how it feels, then stop, do your elbow circles/ shoulder figure 8’s, then run again. Feel better? It worked.
No difference? Back to the drawing board.
Range of Motion Test
Test your range of motion, perform the mirror, then retest. If it increases then the mirror worked.
Maybe something above worked and you’re feeling better. Maybe now you’re saying ‘I should just leave this in the hands of a professional.’ That is a great idea. I received some great insight on this article from Post Physical Therapy and also from painscience.com‘s in depth ITB e-book.
When in doubt, refer out.
Rest is the simplest solution. Howevr, there may be some simple, easy technique to get you back on your feet.
But in the meantime… Don’t stretch it; don’t roll it; don’t touch it.
