Understand the causes of iliotibial band syndrome

Culprits: What causes IT Band Syndrome?

Overuse is one of the most common root causes of IT Band Syndrome. There are usually other factors involved but appreciating IT band syndrome as an overuse injury is an important step in creating a plan for overcoming it. Sometimes this can be as easy as avoiding repetition. Try changing your running routine and implementing more strength training and cross-training. Slowly ramp up your mileage so that your tendons, ligaments, and other connective tissues have time to build strength and flexibility. Keep in mind that this takes longer than for them than muscles. While overuse is usually one of the root causes of IT band syndrome, there may be other factors contributing.

Too much too soon
Increasing mileage or your pace too quickly is also one of the most common root causes of IT Band Syndrome. Long distance running can cause wear and tear on the knees and connective tissue such as the IT band. Ramping up mileage too quickly in preparation for a marathon or half marathon is an all too familiar story that leads to IT Band Syndrome. Muscle can grow and develop much faster than connective tissue such as the IT band. This can leave the connective tissue as the weak link in the chain. In fact, researchers suggest that depending on one's starting point it may take six months to two years of training to develop strong and injury-resistant connective tissue.[13]

This may be the reason that essentially all of the most common running injuries occur in the connective tissue. For example, IT band syndrome, patellofemoral pain syndrome (PFPS) / patellar tendinitis / patellar tendonitis (runner's knee), plantar fasciitis, shin splints, achilles tendinitis / achilles tendonitis, and hamstring tendinitis / hamstring tendinotis are all strains in the connective tissue of tendons, ligaments, or fascia.

Not enough rest and recovery
Rest and recover are key to preventing running injuries. The IT band is a connective tissue, or fascia, like tendons (connect bone to muscle) and ligaments (connect bone to bone). Fascia can take many times longer than muscle to recover from training or heal from injury. This can leave connective tissue like the IT Band as the weak link in the body's bio mechanical kinetic chain.

Running technique
Sometimes IT band syndrome can be eliminated by simply making an adjustment to the running stride. Common problems include overstriding (taking too long of steps), too much knee flexion (bending), not leaning forward enough, pointing of toes inward excessively (pigeon toed). Running with the toes pointed more inward (knee internal rotation) causes the IT band - instead of the quadriceps muscles - to absorb more breaking force at foot strike.[14] Experimenting can be the key to finding what is right for you. Having a professional run a gait analysis can may be helpful.

Tight muscles
Tight muscles in the hips, along the side of the leg, and in other areas of the legs and hips can cause excessive tension on the IT band and therefore may be a contributing factor to IT Band Syndrome. Much of these tissues are connected, so even though the location of the pain is in the knee, the hips and leg muscles may be the area that need to be the focus of recovery. Stretching the IT band and the connecting muscle is more difficult than with most other areas of the body and so may take some practice and time in perfecting it. See the following sections of the website for more on stretching.


Everyone's body is different. Some people are more prone to IT Band Syndrome. Underlying body type and injury or strain history. In the picture here notice how much thinner the IT band tissue is on the knee shown to the left. 


Weak muscles
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.

Running Shoes
Shoes are a runners only real piece of athletic equipment so we tend to really focus on it. Not surprisingly, there is a heated debate on running shoes and whether they have any significant effect on causing or curing running injuries like IT Band Syndrome. There is general agreement though that excessively worn shoes can cause your foot to land unnaturally. Brand new shoes that are not worn in or new shoes that are significantly different from what you were used to may also cause strain and injury. Experts recommend that you experiment with shoes and listen to what your body tells you. Take it very slowly so that your body has time to adjust and  adapt. That means first walking in the shoes for short periods, then running briefly, and slowly increasing use. Changing shoes just before a long race such as a marathon may risk injury. Consulting an experienced sales associate at a running store is probably worth your time and money.

Running on a sloped surface
Running on a surface that is sloped to your side for long periods can put additional stress on the IT band. For example, roads often slope down on the sides and this is normally where we run. Running on this slope for many miles such as in a marathon or in preparation for a marathon can put strain on the knees and the IT bands. When possible it is best to alternate sides of the road. to reduce the prolonged stress. Running on the center of the road when practical is better.


Downhill running (or hiking)
Going down hills puts significantly more strain on the knee including the IT band area on the side of the knee. In fact, pain felt on the side of the knee when going downhills is one of the most common symptoms of IT Band Syndrome.

When going down hills it is helpful to slow down, take smaller steps, and angle your feet slightly outward. Angling your feet slightly outward takes some of the the tension from the connective tissues on outside of the leg (the IT band side) and moves it toward the inner side of the leg (semimembranosus hamstring). This should not be done for long periods though.


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