Runners will often develop Iliotibial Band Syndrome (ITBS) after running on uneven terrain or downhill.
The pain, located on the lateral (outside) leg or knee, can be very debilitating to the point that running or hiking activities have to be stopped.
Even walking becomes difficult. If you handle your pain and symptoms quickly, ITBS can be easily self-treated.
This post will help you discover the risk factors for ITBS, and learn how to quickly return to your running routine with these self-treatment techniques.
9 Tips to Self-Treat ITBS
Iliotibial Band Syndrome (ITBS) is also known as IT Band Syndrome, ITB Syndrome, and IT Band Friction Syndrome. Pain can range from the outside (lateral side) of the leg up toward the hip area to just below the outside (lateral) of the knee joint. There may or may not be notable swelling.
The condition is usually associated with an inflammatory process along the side of the knee. To confirm if you’re experiencing ITBS, first bend your knee to a 45 degree angle. Then feel for tenderness along the outside edge of the knee, where the IT Band is located toward the side of the upper leg.
ITBS is often defined as an over use injury. For runners, a common cause is running downhill. Few runners actually train appropriately for a race with downhill running. Afterward, they end up with a case of ITBS.
I have been guilty of improper training in the past and developed this condition after a 10k trail race. To avoid ITBS, adequately train for the downhill portion of the race. Also, vary your running routine and surfaces while training. Although ITBS is often associated with over use, always address other contributing factors as well.
Risk Factors for IT Band Syndrome:
- Poor hip or pelvic mobility.
- Fascial restrictions and tightness in the lower leg or pelvic muscle.
- Bowlegged, a medical condition known as a varus deformity. It is caused by an inward rotation of the tibia (lower leg bone) resulting in a leg that looks like it is bowed out.
- Total knee or hip replacement.
- Weakness in the hip external rotators and the hip abductors, such as the Gluteus medius and the Tensor fasciae latae (TFL). These muscles are located on the side of the hip or deep in the buttocks.
- Improper training or not being prepared for the terrain.
- Improper footwear.
- Gait or running abnormalities, such as over striding or scissoring (when your leg crosses over the midline with each step).
9 Tips to for Self-Treatment:
1. Improve your mobility.
Poor lower leg or pelvic mobility as well as myofascial restrictions are highly correlated with ITBS. The tighter the IT Band, the more likely it will rub and develop into pain.
I recommend using a foam roller or a Thera-Band Roller Massager to address tightness in the quadriceps and IT Band. You may also utilize a tennis or lacrosse ball to appropriately mobilize the Tensor fasciae latae muscle (TFL). Stretching the IT band or the TFL is very difficult, so I tend to utilize other mobilization techniques. However, I recommend a few pelvic and hip stretches.
Please refer to IT Band Rehabilitation Exercises.pdf for my top exercises, stretches, foam rolling, and self-mobilization techniques to address IT Band related issues.
2. Strengthen your hip muscles.
Weakness in the hip external rotators and the hip abductors, like the Gluteus medius and the Tensor fasciae latae (TFL), can lead to IT Band Syndrome. Strengthening of these muscle groups can help in avoiding future ITB issues.
3. Train for the terrain.
As you prepare for upcoming spring and early summer races, be sure to train for the terrain. If the course is hilly or has a longer downhill portion, dedicate some of your training runs to simulate the race course. ITBS often occurs due to inadequate training for the expected course terrain.
4. Check your shoes.
Your shoes may be worn out and may be the cause of the pain. Remember that the inner cushion and structure of the shoe can wear out before its outer appearance. If this occurs, the shoe can no longer adequately control inappropriate foot and heel movements. This could result in IT Band Syndrome or other hip, knee, or ankle related issues. Shoes typically only last 350-500 miles.
If you are nearing those miles, then it may be time to change. If you’re unsure if your shoes are performing correctly, visit your local running shoe store. The trained staff can inspect your shoes for wear and tear. They may ask you to walk or run in order to watch your gait to fit you in the appropriate shoe. Another option to help control foot mechanics is an over the counter orthotic such as Superfeet Blue Premium Insoles.
In my experience, these insoles can last 1,000 to 1,500 miles easily. If the over the counter options aren’t helping, you may be a candidate for custom orthotics. Please seek assistance from a physical therapist or podiatrist.
5. Have your gait analyzed while running.
Gait or running abnormalities can increase your risk of developing IT Band Syndrome. Over striding tends to occur while running downhill. Scissoring occurs when your leg crosses over the midline with each step. Both over striding and scissoring are easily recognized by a professional.
Check with your local running store or a physical therapy clinic for a monthly gait analysis clinic. If you’re unable to obtain a gait analysis, ask your spouse or a friend to video record you (from behind) while you’re running. Then watch the recording to see if you notice either over striding or scissoring. If you identify either of these two running abnormalities, you will need to adjust your gait in order to prevent ITBS or other running related injuries.
6. Initially take time to rest and recover.
I typically advise a week or two of rest to focus on the mobility and strengthening portion of your recovery. This also allows enough time for your body to complete the acute stage in the inflammatory cycle.
7. Don’t forget to ice.
IT Band Syndrome is typically is due to a specific event. Afterward, there is usually an active inflammatory process occurring. Apply ice to the side of the knee, the outside of the thigh, and on your most painful area. The rule for icing is to apply ice no more than twenty minutes per hour. Don’t place the ice directly against the skin, especially if you are using a gel pack style. Individuals with poor circulation or impaired sensation should take particular care when icing. A bag of frozen peas can be a cheap alternative.
8. Warm up prior to exercise.
Once you are ready to return to running, I recommend that you increase your normal warm up time by at least 10 minutes in order to increase blood flow to the area. This allows for better mobility and also promotes healing as movement is necessary to bring in the nutrients. Once the area is warm, then progress into specific running drills such as walking lunges or butt kickers. Using a foam roller over the lateral leg is also an excellent method to prepare the area for running. Unlike static stretching, foam rolling doesn’t impede performance.
9. Cool down.
After performing your exercises, take extra time to cool down. Spend extra time stretching. I also advise using the foam roller as part of your cool down protocol. Don’t sit for any length of time after your run. Stay active!
Prior to returning to your normal training activities, insure the following:
- Your involved leg is as flexible as the other.
- Discomfort while foam rolling or with mobilization on the affected side is similar to the opposite leg.
- Your involved leg is as strong as the other leg.
- You can jog, run, sprint, and jump without pain.
With proper treatment, this condition should resolve in 2-3 weeks. Severe cases will take longer. As you taper back into your running program, follow these guidelines:
- Although you will need to progress and train for downhill running, initially start with level terrain only.
- Initially limit your running distance. I recommend starting with a distance approximately 50-75% of your pre-injury distance.
- Initially start with a slower pace. Don’t immediately progress back into very intense running activities, such as interval or downhill training, until you have worked back up to your previous running distances and paces without pain. This process may take 4-6 weeks depending on the severity of the case.
- Continue with the rehabilitation protocol until you are performing all of the exercises and running normally without pain. Utilize the prevention strategies outlined above in order to avoid future reoccurrences.
If you handle your pain and symptoms quickly, ITBS can be easily self-treated. If you’re not experiencing relief after two to three weeks of aggressively managing the symptoms, contact your local physical therapist for an assessment and help in managing IT Band Syndrome.
The American Physical Therapy Association offers a wonderful resource to help find a physical therapist in your area. Early management is important for a timely recovery. For additional information on common running injuries and how to self-treat, please visit www.thePhysicalTherapyAdvisor.com.
I purchased both a foam roller and a roller massager and those have really helped my ITBS problems! Thanks for sharing these tips.
Lauren that is fantastic. I use the foam roller for all types of issues especially in the legs and upper back. I’ve never tried the roller massager but I am looking forward to getting one.
Just to clarify since a few people messaged me on my Facebook account. I was referring to the electric vibrating foam roller. I have never used one, but they look intriguing and seem like they would be beneficial. Here is a link to one. Though I have never tried it and cannot recommend it.
http://www.brookstone.com/bodyform-foam-roller?bkeid=search|msn|bidword|foam+roller+massager|c|phrase
Hi Ben,
My name is Virginie and I live in France.
I’ve been suffering from ITBS and PFPS (left leg) for 1.5 year now.
I used to run 45 min-1 hour twice a weak.
I got ITBS first then strong pain in the knee appeared.
I’ve seen all types of specialists (physiotherapists, osteopaths, sports doctors, orthopaedics surgeons, podiatrists, posture specialists, etc.) and tried all sorts of treatments (NSAIDs, massages, shock waves, ultrasounds, strengthening exercises, proprioceptive exercises, foam roller, and I even had an injection of cortisone 3 weeks ago).
I’ve been able to run again last year but after 2-3 training sessions, the pain came back.
I’m really desperate because it’s extremely painful when I walk and go down stairs. Driving has become complicated. And above all, I can’t do any sport and my right knee is now starting to be painful too!
2 MRIs showed that there is an inflammation of the patella. Menisci are okay. Ultrasound scan showed that there is nothing wrong, I mean no bursitis.
My current sports doctor and his colleague-poditarist say that I don’t need insoles and it is probably due to some weaknesses in the upper back and neck muscles. My left hip and thus my left foot would internally rotate leading to my syndromes. Physiotherapy helps for the back pain but not for the knee.
Based on your experience, do you have any suggestions to cure long-term ITBS and PFPS?
Thank you in advance.
Virginie
Virginie,
I’m so sorry to hear about your struggle. 1.5 years is a long time to suffer. The good news is that the MRI scans show nothing significantly wrong. The bad news is trying to figure out what in your running mechanics is leading to the pain. From your description it sounds as though you have seen many rehab professionals. But do any of them actually specialize in treating runners? Each sport is different and even though a person may be a rehab professional it doesn’t mean they are an expert in rehabbing someone involved in a particular sport. In this case, running. From you description I doubt that the low back and neck would cause the knee issues. For most people the reason to get ITBS or PFPS is either 1 of 3 major things.
1st. Something about your running mechanics is flawed causing too much strain in the knee. So you need to have your running professionally analyzed. For example you may need to run with your feet slightly wider apart and/or with a shorter stride length.
2nd. Your foot mechanics are not optimal and so the strain of a poor foot strike is causing excessive stress on the knee. So yes you may need an orthotic and/or a change in shoes and/or a change in running mechanics so your foot can strike the ground differently taking strain off the knee.
3rd. You have weakness in the deep rotators of the hip particularly the glut medius and/or the smaller hip external rotator muscles. This would cause the knee to collapse inward (medially rotate) and this can cause PFPS and/or ITBS.
You need someone who knows how to accurately assess all 3 things to rule in or rule out these issues as potential causes. And of course you could have all 3 issues. Find someone who specializes in runners and see that person. I feel as though this is something you can overcome but it will take someone who can see the details of you as a person and not just treat you like a typical scenario.
I hope that helps. Good Luck! And keep us posted on your progress.
Hi Ben,
I am not a runner but have very similar symptoms to Virginie. The question I have is how to find the type of person you are recommending? I live in Denver CO. Anything would be helpful-I’ve been going through this for over 2 years.
Wow. This has all been so informative. I e had this issue since April. Dealing with a hammy injury in the left leg which caused severe limping- I developed Itbs in the right leg. Left is fine now. It now is not constant but when it flares up I’m flat on the couch .. 27 years running but barely fur 6 months now. Nothing has been very successful treating it — maybe because I’m too active stil? Swimming instead of running- thought that would help. About to go back to Dr …
I’ve had IT band issues for about 2 months, I can typically run between 5 – 7 miles without feeling pain, and then it kicks in. Should I continue to run the miles I can pain free, or should I rest it altogether?
Hi Allison,
Good Question. If your average run is 5-7 miles before pain then I would advise you to taper down the run time for a few weeks shoot for 4-5 miles and then double down on your rehab based exercises. Focus on hip strength as that is likely the issue. As the hip rotators start to fatigue it ends up causing more strain over the ITB and ultimately pain. As your strength improves then slowly taper up mileage keeping a symptomatic. Keep us posted how your recovery goes and good luck!
Hello,
I am having this pain due to ITB since last 6 months and I am finding difficulty in walking and doing daily activities. I am also having pain in my lower back hip region and near the ankle.
What would you recommend?
I went through your material and shall try these exercises, in the meanwhile can I still go to the gym and work out which includes weight training of my back, chest, biceps, triceps, and shoulder?
I will be really grateful for your response.
Best,
Deep
Hi Deep,
Because of the location of the IT Band and how it relates to hip and spinal movement it is not uncommon to have pain locally right over the IT band but also in the back or anywhere down your lower kinetic chain (the legs, foot and ankle). You didn’t mentioned how this occurred, but since you are having low back pain along with the IT Band I would also work towards treating the back pain as it could be the cause of the IT band pain. As far as weight training goes, yes I would continue to exercise and train as you work through the rehab portion. Here is a link that might be helpful for your low back pain. http://www.thephysicaltherapyadvisor.com/2016/05/18/5-tips-to-prevent-low-back-pain-during-diy-projects/
Hi,
I have been training for a marathon which is in 3 weeks. My right knee had been hurting me, so I took a week to cross train (swim, bike). I decided to run a week later because I thought I would be fine taking a week off. I ran 11 miles and felt amazing. However, on my 12th mile, my LEFT knee started killing me. I was in so much pain I had to stop running. I swam this morning, but now I am terrified because I really want to run the marathon. What do you suggest? I believe I have some form of ITBS because the sides of my left knee have been in a lot of pain. Should I swim and bike, as well as do the strength exercises? Do you think I’ll be ready to run the marathon?
Thank you
Hi Marisa,
There are a lot of factors to consider on whether or not you will be ready for the marathon. If you have done one before or at least have done 20+ mile runs before and know how to pace your body and fuel then you maybe okay. 3 weeks is an awkward time frame given you will be tapering soon and probably want to get at least 1 more long run in. But it is always better to enter a race without pain or injury. So yes I would back down the running, continue with cross training and work really hard on the rehab. It does sound like it may be IT band issue. Foam rolling is always a place to start but there is likely a mechanical cause to your issues such as weakness in the hip rotators and abductors such as the glut medius. There are also other good ways to mobilize the tissue other than a foam roller such as a mobilization band and plunger. You may want to check out the Resilient Runner program. It has a lot of information on this topic. Good Luck! https://marathontrainingacademy.clickfunnels.com/optin10735340
I have been suffering from an ITBS injury for about 14 months after training for a half marathon. I have been to 2 diff. PT’s, chiropractor, and a sports med doc. I foam roll daily, tried self cupping, and do hip/glute strength exercies (clam shell, monster walk, hip hikes, bridges). I deadlift, weighted lunges, leg press, etc. I had xray that was clean, and mri that only showed some swelling along the IT band near knee. I am extremely frustrated. I have taken 3 months off now running and still have knee tightness and pain throughout the day. the PT I went to specialized in running. just keep saying I need to work on hip strength/tightness. any thoughts or help. I need to get back to my regular running routine with no pain. thanks
Thomas…..wow…..sure sounds like you are doing all the right things. When the PT assesses you does your hips still show weakness? Particularly in the deep rotators and the muscles that externally rotate your femur? Lastly has anyone assessed the mobility of the fibular head? Restriction in the head of the fibula can cause ITB type pain.
Hey
So I’ve been experiencing pain in my outer knee for three weeks now. It kicks in after 5 mins of medium paced running
Visited a sports injury specialist. He gave me a set of exercises to do. I’ve been doing stretching for my hamstrings, quads, calves , pigeon stretch for the glutes as well. I’ve been doing these exercises for 10 days now.
Resumed mild training , but the pain kicks in after a few minutes. Tried doing wider steps incase the problem was in my stance
I’m thinking it’s probably because I have weak glutes and as soon as they get tired the pain flares back up.
Haven’t tried foam rolling yet because I do not have access to one, if you could suggest an alternative that’d be helpful.
Also, this pain started when I’d resumed running after a 3 month gap , covered 3km in around 18mins, and an hour later my outer leg started paining.
I’d be grateful if you could help me out, I have an important event in 10 days and I need to run for that, I’d be grateful if you could suggest ways I could continue running with itbs, while doing rehab.
Thanks 🙂
HI Varun,
You are likely on the right track with addressing weak gluts typically the glut medius as well as the deep external rotators of the hip. I would continue with the exercises prescribed and here is a link to a YouTube video that shows a different method of self mobilization you could use in place of a foam roller. Good Luck! https://www.youtube.com/watch?v=5acTiBYEszU
I started training for a half marathon a couple weeks ago. One day after doing an intense workout I fight tightness in upper thigh, and then after I was done extreme tenderness to the touch on my upper outside thigh under my hip and butt. I took several days off and iced and eventually it went away. Yesterday I did a 4 mile run with no pain until about an hour after. It’s that same super tender to the touch upper outer thigh, now on both legs. Only hurts when I touch it or sit. I’ve tried foam rolling, but it’s too painful. I don’t know what this is, but it’s really making me worried I won’t be able to continue training. I have new shoes so that shouldn’t be causing it. What should I do? How can I fix this? I went to the doctor and they didn’t help at all. Is this IT Band issues? Can I get back to running?
Hi Kate,
I’m sorry to hear about this pain. From the description its hard to know if it is IT Band pain or not. But since it has occurred after running both times now I would suspect you have a muscle imbalance that is causing you to either over use other muscles or is altering your running pattern which is leading to overuse in other areas. the most common reason to develop this is weakness in the deep hip external rotators. I would start with the rehab protocol listed in the article and taper back your running for 2 weeks. After two weeks on the exercises listed which should be done 3-5 times a week then slowly taper back into your prior running over the next 2-3 weeks and see how it is feeling.
I just developed ITBS two weeks ago on mile 6 of a 9 mile run. I’m training for my first marathon. This marathon is Thanksgiving, and I’m still out of commission. I can walk without pain, but my it band is extremely tight when massaged and hurts badly. I haven’t ran in 2 weeks. My PT said I developed it from a weakness in glutes and overpronation, which I already have specific shoes for. I was told that I cant start running until I train myself to not overpronate and run with my knees out. Do you think it’s even possible that I would still have the time to train for my first marathon? I already spent so much money on it…
HI Anne, yes you definitely have time. If you already have shoes to help correct the over pronation I would concentrate on hip external rotator and glut medius strengthening exercises. There are a lot of tips on how to self treat ITBS in this post and here is a link to a video I did on a different way to help with the tightness. https://www.youtube.com/watch?v=5acTiBYEszU If you want to save money in the long run and want a more thorough set of exercises and self treatment recommendations you may consider the Resilient Runner Program. Here is the link. https://marathontrainingacademy.clickfunnels.com/optin10735340 But either way if you start now you definitely will have time for a Thanksgiving Marathon. Best of luck.
I don’t really have a question like the others but I just wanted to say thank you for all of your knowledge, Ben! This article and seeing your response to other people has been very helpful.
I’m training for my second marathon (first one was 5 years ago) and I think I’ve got my first encounter with ITBS… I’m actually taking it slower than my first one and I’ve been strength training over those 5 years so I’m quite surprised this has happened! But maybe this is a reality of getting older! Haha!
Fingers crossed that these self treatments work!
Hi Tansy,
Thank you so much for the kind words. Injuries and pain are so frustrating. Sometimes they just creep up on you. I’m sure you will battle through. Be sure to address any potential hip external rotation weakness as that is often the cause of ITB pain. Best of luck and thanks again for the kind words.
Hi,
I’m currently training for the London Marathon (28th April) and have got up to 18 miles in my training and have just developed ITBS.
I changed my trainers prior to my last 2 runs to a pair of Adidas Pure Boost (from Adidas Response). Could this have caused the ITBS?
Also I was looking at running a sub 3:30 marathon. Is this still realistic? I’ve been running at marathon pace for most of my long runs.
I’m really hoping these self treatments do the job!
Hi Dom, Good luck in April !
It is possible that the change in shoes spured along the pain. Different shoes can affect your running form. The issue now that it is inflamed is that changing back might not take the pain away right away. You have to work on getting the inflammation out while looking at any other possible factors causing the pain. If your interested there are even more self treatments found in the the Resilient Runner Program on the MTA site.
Best of Luck!
Hi,
I am running my first marathon in 4 weeks time in Paris. I have managed to do 3x 16 mile runs but on my last run, I started to develop pain on the lateral side of my left knee. I gave myself 5 days worth of rest (no exercise at all), and this morning after running 4 miles, I had to stop as I could not tolerate the pain. I think I may have iliotibial band syndrome, based on the location of the pain. I have flatfeet and do wear proper running shoes for my overpronation. However, I do think I need to invest in a new pair as they feel worn out. I am going to focus on strength training, mainly focussing on my glutes.
What do you think is the best way to go forward regarding my pain? I can’t really afford to see a specialist as I’m only a University student. I’m thinking of going on the cross-trainer for now as well as go on the bikes at the gym. I am really worried as I have a half-marathon in 2 weeks time, then the marathon in 4 weeks. I really want to be able to do the marathon as I’ve trained so long for it!!
HI Patrick,
I think you are on the right track. I would definitely be sure you have a newer pair of shoes. Also working on the glut medius and hip external rotator muscles typically is helpful. Initially for the pain you can foam roll and try this… https://www.youtube.com/watch?v=5acTiBYEszU
Also follow the advice in the article and hopefully you will get back on track.
Good luck on the two races. Let us know how you do.
I am not even sure I have ITBS however I crack my left hip joint a few times a day but recently for the past few months I have had a great deal of pain running down my left leg starting at my hip. Is this related and should it go away on its own or should I see a professional to seek help?
Bridget the short answer is yes. ITBS pain can go all the way down the leg and even cross the knee joint. And this kind of pain is never normal. There are other reason’s to get pain in the hip that migrates down the leg. Popping or clicking in a joint may or may not be related and usually that can be determined on examination. If the pain continues I would have a professional examine the hip.
Hi Ben,
Self diagnosed itbs here, but I’m 99% sure I got it right. I was marathon training for my first full last December. I am a self-taught runner. The pain came in the middle of my first taper weekend. I power walked most of the marathon. I have been nursing it ever since, but I haven’t completely stopped running altogether… just scaled back significantly (like one 3 mile run per week). Pain is still there and shows up around mile 2-3. Would you suggest stopping 100%? I have been on the exercise bike a lot to try and keep my endurance up. I have been working on my running mechanics a lot lately and trying to stretch better and build gluteus muscles (something I failed to do before the marathon).
I signed up for a half marathon on 3/7 before the pain started last November. The pain isn’t terrible, but it definitely slows me down to a walk when I’m competing. Thoughts?
Thanks for your time and advice!
Well that is a good question. I think I would skip the half for sure. I would not stop running all together but I would would probably limit my running to 1-2 miles only, stopping before any pain and really work hard on my running mechanics. With short runs like this you have to be very good about a thorough warm up and cool down though. Not sure if you are working on the soft tissue in or around the IT band but I would. If you are only foam rolling try using a different technique such as cupping. Here is a link to an old video I did. Hope that helps! Ben https://www.youtube.com/watch?v=5acTiBYEszU
Hey Ben,
I was wondering if walking daily while recovering from it band syndrome would delay recovery?
Thanks,
Julia
Hi Julia…It really depends. If the walking does not cause more pain then it is likely fine. I would try to avoid any hill walking or walking on a slope which tends to aggravate IT Band pain. So the short answer is…..pain will guide you if you should be walking extra or not. No pain = okay to walk. Hope you feel better soon. Ben
Hi Ben,
Two weeks ago after a long 15 mile run, i started getting pain in my knee and soreness in my quad. I have since been diagnosed with ITB syndrome and my gait analysis shows that i have a slight pronation when running.
I am currently in the middle of training for the London marahtonin april, and thus had scheduled a half marathon for this weekend. I have rested the knee for two weeks, and the shooting pain has gone but there is still a dull ache when walking/going up the stairs.
I really do not want to miss this half marathon, as its a new area and route i havent explored before. Is it going to be damaging to take part? I feel that i am already falling behind in my training schedule.
Hi Ben,
I have ITBS and suffered for the last 6 years. My glute strength has much improved in the last 6 months after a course of physio but still suffering. I have taken time off running and cycling (apart from necessary walking/cycling commutes and a handful of bike rides) after following advice from my stumped physio. Cycling doesn’t seem to trigger pain but it’s bad enough that over the years walking quite far in a day can set it off, never mind a run. Do you think I’m missing a trick by not completely resting entirely? My leg isn’t painful but I’m conscious it can be tight or ‘dodgy’. Thoughts would be massively appreciated.
Two weeks ago after a long 15 mile run, i started getting pain in my knee and soreness in my quad. I have since been diagnosed with ITB syndrome and my gait analysis shows that i have a slight pronation when running.
I am currently in the middle of training for the London marahtonin april, and thus had scheduled a half marathon for this weekend. I have rested the knee for two weeks, and the shooting pain has gone but there is still a dull ache when walking/going up the stairs.
I really do not want to miss this half marathon, as its a new area and route i havent explored before. Is it going to be damaging to take part? I feel that i am already falling behind in my training schedule.
Many thanks,
Tom
Hi Tom, This is a difficult question to answer. One never knows how he or she will respond to pushing through an injury. If you still have soreness then the area has not fully recovered and the likely cause of the injury has likely not been dealt with. You are unlikely to damage the area but there is a risk that you flare up the area and end up having to take additional time off to recover. Or you may run it and be okay. There is no definitive way to know, so it is your call though I would say there is risk. To address the route cause you may consider a motion control shoe and/or an orthotic to control the pronation but either one needs to be slowly tapered into to avoid other potential issues.
Long term you likely need to address the strength in the deep external hip rotators to insure they can help support the foot by controlling excessive femoral internal rotation which can lead to foot pronation.
I hope that helps!
All the best!
Ben
Hello,
I’m curious to know if any pain in the side of the knee is itbs or it band stiffness, is there a difference? I had itbs once last year from running improperly in addition to increasing mileage very quickly.
I’ve been running only three times a week 2 miles each time and most recently I started a sprint program, I noticed some stiffness around the same area I hurt last year. It really hurt having itbs trying to run last year and I don’t want it to happen again.
I’m trying to train for the military and I would prefer not to deal with another itbs injury for I’m trying to build up my running endurance and drop my pace.
Is there any way that I don’t have itbs but a tight it band? And can prevent itbs from happening by stretching?
Hi William…yes there are other options other than ITBS. It can be your lateral collateral ligament (LCL) though typically that is sprained after a fall or something. You could have a hyper or hypo mobile fibula or fibular head causing ITB issues. You may also have a muscle imbalance in your hips that is leading to ITB issues. Just to name a few. IT band stretching is rarely that effective. I would advise different mobilization techniques if you feel it is tight. There is an extensive write up in the Resilient Runner program if you are interested. Along with information on almost every other common running issue. Might be worth the investment if you are trying to get in the military and will be doing a lot of running. Ben https://marathontrainingacademy.clickfunnels.com/injury1
I have had a total hip replacement, through the front. Also I have had knee surgery for a torn ACL, PCL, and partial LCL. Not sure which of two, pcl orlcl was the partial. Dr. Repaired the acl only. I also spent a year in body cast for a dislocated hip as an infant. Any how, fast forward to age 63. I do a lot of walking but I get searing pain on outside of that leg starting several inches above knee and also several inches below hip joint. It is like totally searing. I was trying to walk 5 miles several times a week. Do you have any ideas for me? Thank you as I am feeling despate.
Hi Yvette, Given your complicated history I would have imaging completed to make sure there isn’t anything wrong with the surgical repairs. Once that is cleared out then you have to look for muscle imbalance throughout the kinetic chain that could be responsible as well as rule out a lumbar issue. You should definitely find someone that has experience in more complicated orthopaedic matters. It is likely very treatable but you need to be sure you rule out bigger issues before proceeding forward. Best of luck!
Hi Mr Shatto, Interesting website you have here!
I am diagnosed ITBS by my physiscian, but pain is located left outside below the knee. I am resting 2 entire weeks already, but pain keeps persisting. There is also a swelling (feels like a hard tendon) below left below my knee; between the kneecap and the top of my shin bone.
I went to the physician already two times. The first time the pain went away after two days, and according the doctors advice i picked up running for extensive runs only, but after 3 runs the pain came back and never went away (since 2 weeks now)
Second time he confirmed the ITBS diagnose.. But I am not sure I can trust him because swelling is below the knee, and because first adice made it worse. What do you think? Best to get a second opinion with another physician?
I am working with all power, strecht and massage tips i can get, and wednesday I start up physical therapy. But the swelling worries me a bit. I am an experienced runner (3500km a year,) so I am eager to start running again.
Hi Pieter, It is entirely possible you have two different issues going on. The swelling below the knee cap sounds suspicious for patellar tendonitis. You may also have some patellar femoral pain and or ITBS. Since you are an experienced runner the key is to find out what was different that led to this issue in the first place. You need to correct that for full resolution. In this case if the symptoms don’t resolve after 4-6 weeks an additional opinion maybe warranted. But start with the PT first. Here is a link to a post that may also help you. All the best! Ben https://www.thephysicaltherapyadvisor.com/2014/12/15/how-to-self-treat-patellar-femoral-pain-syndrome-runners-knee/
Hi Ben, thx for quick response.
Small update: Started wearing compression socks today, and stopped massaging the swelling yesterday after reading a website were was stated that in case of ITBS the swelling below the tendon should never be pressed. It seems the pain is already better today.
Hope PT (tomorrow) can give extra advice.
Thanx for info on patellar tendonitis as well. Fortunately, focus is on hip strenght, which I am training the last weeks already. So I am countering both possible issues already :-).
I have been dealing with ITB for over 2 years now. 3 orthopedic doctors told me nothing showed on the MRI that I have ITB syndrome. The 4th orthopedic doctor said he seen a meniscus separation said that might be the cause of the problem I got surgery but the ITB has not gone away. My lowest peak I would take about 4-5 steps and feel like a knife was stabbing me in the outer part of my left knee. I have gained some strength back as I have tried everything possible spent a lot of time and money and I still can’t go on far walks let alone try to run. I have been to tons of doctors, PT’s, Cortisone shots, acupuncture, foam rolling, lacrosse ball, massages, professional stretches, hot baths, cold baths, ice, strengthen exercises everyday, signed up for gym with trainers, changed the way I walk heel to toe, will change the way I run if I can ever get back to it. I have not lost total faith but I am completely drained mentally and physically. If there is anyone out there with any advice for me I would highly appreciate it I am searching for a solution I will not give up.
Hi Joseph….Please don’t give up hope. In cases of chronic pain like you have experienced and continue to experience I highly recommend a very different approach. Start by reading this book. https://www.amazon.com/Why-Do-Hurt-Adriaan-Louw/dp/0985718625/ref=sr_1_2?dchild=1&keywords=adriaan+louw&qid=1627174399&s=books&sr=1-2
I hope it will give you some insights and ideas on where to focus or not focus your efforts going forward. All the best! Ben
Thanks I just bought it.
I have been spinning for twenty years and was diagnosed with IT band syndrome — that may have led to mild thinning in patella cartilage. With walking on hard surfaces all of a sudden I had severe knee pain and couldn’t walk. I stretched, strengthened and used foam roller in all of suggested ways and did PT several times and the issue kept returning following walking on hard surfaces. I’m 61 now.
At this point I’m not sure what to do as it doesn’t seem to heal and I’m not ready for knee replacement. It’s actually very serious and disabling — not a minor issue at all. I’ve bought Z-coil shoes and Hokas which both help quite a bit, especially the Z-coils for walking. The TFL is extremely tight on one side and now the hip is even getting more limited mobility but most pain is felt in the knee.
A Pt has done some needling in the TFL which helps and cortisone shots near that region also helped. I have strengthened gluts, hips, quads etc. And I am focused on posture, had shoe orthotics. I do have scoliosis perhaps contributed to some imbalance in hips.
HI Wendy…The scoliosis could definitely contribute especially if the curve is significant. The problem with long term issues like this is that the body starts to compensate in many ways. The knee pain can ultimately cause compensation patterns up and down the kinetic chain leading to even more issues. With clients like you I always start at the hips and work down with a heavy focus on the deep hip external rotators. However, if the pain and dysfunction is very severe and chronic a knee replacement maybe the best option to prevent further damage to other areas of the body. Once other areas begin to compensate and wear out then it takes more than one replacement surgery and often times people continue to have issues. My advice is to not let this linger. If you have truly tried everything then you may consider replacement before you have additional issues. Wish you all the best!
I had a complete knee replacement in June 2021. I kept telling my therapist that the side of my knee hurt worse than the knee replacement. Here 8 months later I still have the pain. It’s so bad that it wakes me up at night. And now I can hardly bend my knee because it swells so bad. Do I go back to therapy?
You could definitely try going back to therapy, but maybe a different therapist. I would also follow up with the surgeon and have x-rays done to insure everything looks okay with the bone and implant.
Hello,
I have recently experienced pain on my outer knee which I think is caused by ITBS. I think it’s because I’ve been doing lots of walking recently and on days I don’t walk it doesn’t hurt. Is this possible? I don’t really run and prefer weight training in the gym. Is it ok to continue with the gym e.g squats/lunges/hip thrusts? I’m also going to try and incorporate the exercises you suggested on a daily basis but I’m a little concerned because I already do banded exercises at the gym but have still developed knee pain…
Thank you!
Yes…you should be able to do any activity that does not make the pain worse at the time. I have found most people do not do the banded exercises correctly. Here is a link to a video that may help. I have other useful videos on my YouTube page as well. Thank you! https://www.thephysicaltherapyadvisor.com/2020/05/06/the-clamshell-a-go-to-exercise-for-treating-foot-hip-and-knee-pain/
Somewhere in my research to heal Iliotibial band syndrome I came across using fists to tap on thigh and toward knee. Can you share how I can do this. Thank you for your expertise!
Interesting question. You are describing a massage technique similar to what is call Tapotement. I’m a bigger fan of using cupping or other techniques.
I have relatively recently been professionally diagnosed with ITBS in order to start rehabilitation at a local facility after realizing I could not fix my pain that I have been experiencing for about the past 5-6 yrs. Unfortunately when I was diagnosed with ITBS in my left leg, I was also informed that I have arthritis in my left hip. Rehabilitation seems to be going well and thankfully I have been working effectively with great therapists at the facility I go to for the past 3-4 mos, but what a guessing game it is to solve this dilemma! I just want to say that reading all the posts on this website has been very encouraging to me because I can feel from where everyone is coming, and hope we can all ‘stick to our guns’, so to speak, and hang in there, it can be so frustrating some days! Btw, I’m 67 yrs young and have been exercising religiously since I was 17 yrs young. Oh, I do have one question, is it possible that the arthritis in my left hip affecting the rehabilitation of my ITBS, or visaversa?
I broke my femur many years back…. Never had a problem with it until I used it stretching exercises…for bad knees…. now I can barely walk. I feel ghost pains and throbs where the thigh bone was broken. Could I possibly have reinsured the break? Totally lost
Hi Ben, Thank you for this really informative article and your answers to the many questions. I walk/hike daily, do strength training, hockey and spinning. I’m 59. For a year I have been awakened in the night with right lateral knee pain. It never hurts during any of my sports. I have hallux limitus on my right toe. I have had tons of physio, acupuncture, shockwave and massage. Nothing has really helped and I am resigned to just getting a bad sleep. I had an ultrasound and X-ray and was diagnosed with ITBS even tho it doesn’t hurt when I walk, run, cycle or go down stairs. I’m now working on strengthening the glutes and hips. Do you have any other ideas for what I might have and what might help? Much appreciated.