iliotibial band syndrome rehabilitationI have IT Band Syndrome: What should I change?

Rest
The good news is most people will recover from IT Band Syndrome and be back pounding pavement without too much time off. For some, resting may be difficult but it is probably the most important part of the recovery path. The good news is muscle atrophy doesn't start for a few weeks so nothing is lost by taking some time off. Also, muscle memory helps muscles build back quickly even after some time off. Skipping the rest phase of recovery can worsen the injury and creates the risk of long term scarring and deep rooted chronic injury.

Rest

Running technique
Susceptibility to IT Band Syndrome is likely related to biomechanical differences in running technique (stride, gate, cadence, lean, leg rotation, foot strike, etc.) and studies have been conducted to look for these association. The studies have found some relations but have been mostly inconclusive.[1] It is also not known if biomechanical differences were a cause of IT Band Syndrome or if runners develop biomechanical differences after experiencing IT Band Syndrome. One of the primary challenges results from not having a precisely controlled group of study participants. For example, there are vast differences in individual runners including age, sex, weight, height, body type, fitness level, injury history, pain tolerance, running frequency, type of running, competitiveness, etc.

Stretching
The IT band itself can’t really be stretched significantly - it is a large fibrous connective tissue that is extremely strong and tough! So IT band stretching is more targeted at the muscles. These muscles are in the lateral thigh and connect to the IT band and include the tensor fasciae latae and gluteus maximus muscles. The tensor fasciae latae creates substantial tension to the iliotibial band that serves to brace and restrict the knee from sideways bending.

Stretching the muscles associated with the IT band is difficult but is very important since muscle tightness is very often contributing to the problem. IT band stretches are a bit awkward so plan to practice and repeat them routinely. Like all stretches you will get better and be able to feel their effectiveness after you have perfected them over time.

Warm up your muscles before stretching. Avoid stretching immediately after waking up since muscles and body tissues can be very tight after long rests. Walk or begin any other activity that will warm up the leg muscles before stretching.

Foam rolling
The IT band is extremely strong so the purpose of foam rolling is not to stretch the IT band as it is not really possible to change the tension of the IT band using a foam roller. The purpose of foam rolling the IT band is to massage and loosen tissue. It is also thought that foam rolling may be able to break down knots, scarring, or bad adhesions between the quad muscle and the IT band.  Start easy if you are not used to foam rolling as doing it in a way that is painful may result in further injury. It also takes a number of days to get the hang of it so that it is comfortable and effective.

Strength exercises
A weak muscle, or group of muscles, can throw the body out of balance by shifting too much work load onto another area of the body. This can lead to poor running form and injury. Strength training focused on a weak muscle group may help in overcoming IT Band Syndrome. For example, Fredericson et al. found that, "Long distance runners with ITBS have weaker hip abduction strength in the affected leg compared with their unaffected leg and unaffected long-distance runners."[4]

Strengthening the hips and gluteus maximus is a valuable treatment strategy for IT band syndrome. These muscles control rotation of the femur, position of the pelvis.

Try some of the exercises here to target muscles most commonly associated with IT Band Syndrome.

Massage
Massage is probably more important for IT Band Syndrome treatment than most other injuries. This is because the IT band and surrounding muscles can be very difficult to stretch. There is no concentric / eccentric motion. That is to say that there is no push / pull nature associated with the IT band so there is no way to easily bend the knee sideways to stretch the IT band and associated muscles. For this reason massage is a good weapon against IT Band Syndrome.

Unlike some areas of the body such as the back, self massage of the IT band and associated muscles is not difficult.

According to Kerrie Ann Frey, massage "dilates blood vessels, which helps them work more efficiently to promote circulation. The manual assistance of encouraging venous blood flow back to the heart enhances blood flow, which delivers fresh oxygen and nutrients to the tissue and promotes the removal of waste products and toxins." Click here to see her full article.

Inflammation
Inflammation is a stressor that can cause pain and discomfort. Inflammation can make a bad situation worse when swelling occurs in a tight or restricted area of movement such as where the IT band passes along the side of the knee. In other words, there is not much extra space between the IT band and the side of the knee so inflammation there may result in increased friction, wear, and irritation. Managing inflammation is an important consideration for IT Band Syndrome.

Tapes, braces, and bands
There has been no scientific study showing that the use of tapes, braces, or bands provide any benefit for IT Band Syndrome. There is also no scientific explanation for why they would provide any benefit. However they are no uncommon so clearly some people feel that they provide some relief. Others feel that the rubbing or pressure from tapes, braces, and bands causes further irritation or annoyance. Addressing and working to correct the root cause of the problem is a more recommended approach.

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Weight
Controlling body weight is important. Extra weight puts extra stress on the knees when running. Carrying the extra weight for long runs - especially the long miles of training for a half or full marathon - can put significant strain on the knees. Losing weight is another one of those things that it very simple but not necessarily very easy but can help address IT Band Syndrome.

Other daily activities
Other daily activities may have a significant affect on the IT Band Syndrome. These activities include how you sit, stand, walk, climb stairs, ride a bike, drive a car, sleep, and more.

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