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    Kevin Sherman, DC, ART

  • IT Band Syndrome: Ouch! My Knee Hurts!

  • The most common cause of lateral knee pain in runners is Iliotibial Band Syndrome. “IT band syndrome”, or “ITBS”, most often presents as pain over the lateral knee which appears during or after running. The pain often subsides immediately or within a few hours after running, but returns with every run.

    The IT Band

    Anatomically, the IT band is a long, thick structure running along the lateral portion of the thigh, from the hip to just below the knee. It essentially acts as a long tendon of the gluteal muscles involved in moving the thigh out and back (hip abduction and extension). Structurally, the IT band is extremely dense. It is more akin to a leather belt than a spring. Like a tendon, it has very little give, and for all practical purposes, it does not stretch. One can place a stretch on it, but that does not mean it will give. For eons, athletes with ITBS have tried to statically stretch the IT band with little, if any, lasting effects. Treating symptoms rather than causes has little value when dealing with this syndrome.

    IT Band Syndrome

    In runners, abnormal tension develops within the IT band due to WEAKNESS OF THE HIP ABDUCTORS (GLUTEAL MUSCLES). That’s right, your knee pain is rooted your buttock, not your knee. If the gluteal muscles are not strong enough or are not firing properly, the knee will drift inward after footstrike, placing additional stress on the IT band. The resulting compression of the soft-tissues over the lateral knee eventually leads to inflammation, myofascial adhesions, scar-tissue and pain, otherwise known as Iliotibial Band Syndrome.

    IT band syndrome is no longer considered a friction syndrome, as it once was. It appears to be
    more of a compression syndrome in which the IT band repeatedly compresses and irritates the
    soft-tissues over the lateral side of the knee and thigh.

    Research has shed much light on gluteal weakness as one of the primary causes of ITBS. In 2000, a
    pivotal study was done by Michael Frederickson, MD, and his colleagues at the Stanford Department
    of Functional Restoration 1. In the study, athletes with IT band syndrome had significantly weaker
    hip abductors than their uninjured counterparts. After completing a strengthening program
    targeting the hip abductors, the injured runners showed significant improvement in their symptoms.
    Symptom improvement paralleled the improvement in hip abductor strength, in fact. The program
    also included static stretching; however, the therapeutic benefit of static stretching has been
    called into question and

    is currently under significant clinical and scientific scrutiny (perhaps the subject of a future

    This is somewhat consistent with what we see clinically; Athletes with IT band syndrome almost

    display a relative weakness of the hip abductors. Strengthening the gluteal muscles and treating
    the soft-tissue fallout generally results in a functional cure. Treating the weakness or the
    soft-tissues alone only provides short-term relief. Both problems must be addressed in order to
    effect lasting change.

    Clinically speaking, along with exercise, soft-tissue therapies designed to flush edema and break
    up scar and adhesions, (e.g., Active Release Techniques, Graston Technique, etc.) are very

    Besides gluteal weakness, there are certain activities that can cause acute IT band syndrome:

    -Too much volume or distance, too soon (overtraining).

    -Running downhill.

    -Running on cambered roads.

    -Extreme muscle development of the quadriceps (muscle bulk adds to the compression of soft-tissues
    sandwiched between the muscle and the IT band).


    Common self-employed techniques for treating and preventing ITBS include regular use of the foam
    roller over the quadriceps, IT band and gluteal muscles, dynamic (not static) stretching of the
    gluteal muscles and strengthening exercises involving the gluteal muscles involved in hip
    abduction. See below

    for a few of the exercises you can try on your own.