As any runner knows, their sport can be brutal on the IT band, and unless you stretch it thoroughly and avoid overtraining when it's acting up, it can lead to painful injuries that are a nightmare to treat and deal with. (Not trying to scare you, but yeah, it's true!) And while IT band complications can happen from any strenuous activity, it's super common in the running crowd.
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"The many repetitions of foot strikes during the course of a run magnify the imbalances present in the hip and make the IT band work overtime," says Kristian Flores, CSCS, a fitness coach based in New York City. IT band pain is also a sign of imbalance between leg length and tension in the muscles of the hip, he says, and if left untreated, can lead to back problems and knee pain.
First Off, What's the IT Band?
"The IT band, or iliotibial band, is a tract of fascia the runs along the lateral of your knee, up to the outside of your hip," says Leanne Pedante, running coach and head of the training program for STRIDE.
Think of wearing a pair of jeans. The IT band is like the seam of your pants that runs from your hip to your knee, she says. It plays a big role in extending and rotating your hips, abducting your legs (moving your leg out to the side) and stabilizing your knee.
How Does It Get Injured?
The most common cause of IT band injury is dysfunction in the hips. "Generally, this is characterized by poor balance between the inner and outer muscles of the hip," says Flores. "Tight or weak buttocks (glutes) are a major factor, as is a tight hip flexor muscle from sitting excessively." The inner thigh muscles are the other half of the equation, and thus keeping these muscles strong helps create balance in the hip and to ward off injury.
Common external factors that can contribute to IT band pain include consistently sitting with legs crossed or in lotus position, running on a sideways-tilted surface where one leg is continually downhill or wearing shoes that cause your foot or knee to rotate and collapse, says Pedante.
Since the IT band crosses the hip and the knee, you might feel some pain at the hip when it's injured. But an IT band injury most commonly manifests as knee pain, Flores says.
Here's a tip: If you run and your knee is wobbling, it will put strain on the ligaments in the knee and can lead to a serious tendon injury in the knees. "Keeping the knee tracking properly is important and any small deviation from true alignment will show up as pain as the miles add up," he says. So, be super careful!
What Types of Injuries Happen?
If you're pounding the pavement with sprints or taking six-mile runs every day, you could experience an overuse injury, especially if you're not taking days off for rest or switching up your workouts.
If it's inflamed, you'll notice swelling and micro trauma, which will cause pain and tension. When ignored or left untreated, you could suffer long term damage to the IT band tissues.
"Prolonged bouts of running without sufficient recovery can lead to ITB syndrome, a painful swelling of the IT band tissues," he says. ITBS usually feels like a sharp pain on top of and outside of the knee joint and can make every step quite painful, says Pedante.
What's more, "female runners are also more prone to knee injuries as they have wider hips (what's called an increased Q angle, which leads to the quadriceps muscles pulling the kneecap away from its groove, causing discomfort)," Flores says.
How to Prevent IT Band Injuries
"It's easy to get excited about your new running journey, and go from never running to suddenly running five times a week. This sudden increase in training volume is a really common source of injury, though," says Pedante.
Generally, beginner runners should increase their weekly mileage slowly. If you start out running two miles, two times a week, do that for several weeks so that your body has time to adjust, then gradually add on to your frequency or duration — but no more than 10 percent a week.
Consider having several pairs of running shoes that you cycle through. This way, your gait doesn't risk getting locked into one position for tens of thousands of steps, says Pedante.
To help keep the IT band in tip-top-shape, incorporate regular stretching into your fitness routine, as well. "The IT band itself isn't what deserves the most attention. Rather, the main muscles that attach to it are what require focus," says Flores. These include the glutes, quadriceps, hip flexors and the TFL (tensor fascia latae). Here are some of your best options.
Read more: Avoid Runner's Knee With These 5 Exercises
What's great about this stretch is that it targets the quads, hip flexors, obliques and neck, Flores says, all of which can get very tight on runners. Ease in slowly and don't jerk, so you can keep your joints safe and really feel the deep stretch.
- Lie on your side with your head and neck supported.
- Bring your top knee forward toward your chest.
- Use your lower arm to grasp the leg behind the thigh and pin the knee down.
- With your upper arm, reach back and grab your lower foot or ankle if you're very mobile.
- Turn your head toward the back foot and pull the leg into a stretch.
- Take 20 deep breaths, then switch sides.
2. Step-Up With Knee Lift
This stretch targets the glutes, hamstrings and hip flexors, and it improves strength and balance, says Flores. All of the will help you feel more centered when running and reduce tension in the hips and lower body.
- Find something sturdy like a park bench or a high step.
- Plant one foot and exhale as you stand up onto the bench or step.
- Bring your trailing leg up toward your chest and pause for one second.
- Step back down. You should lower yourself and not drop back down.
- Do 15 reps per leg.
3. Banded Clamshell
"I like to do this exercise with a mini band around both legs, about one inch above the knee joint," says Pedante. The mini band adds a bit more tension to help further strengthen the hips, inner thighs and glute muscles.
- Lie down on one side, stack your legs and bend your knees at a 45-degree angle.
- Support your head with your bottom arm.
- Rest your top hand on your hips to make sure that your hips stay stable throughout the movement.
- Keep your feet together and your core tight as you raise your top knee as high as you can without shifting or leaning your hips.
- Pause and return the top knee down.
- Perform 2 sets of 20 on each side.
4. Banded Side-Lying Leg Raise
"I like to do this exercise with a mini band about four inches above your ankle joint," Pedante says. "It's important to remember that the IT band is a band of very tough tissue. Actually stretching this tract of fascia would take more force than we have," she says.
Because it doesn't contract and soften the same way that muscle tissue does, you can't expect to treat it the same way you would a pulled hamstring muscle. That being said, stretching the muscles around your IT band can help alleviate discomfort. "This seated hip stretch is one of my favorites," she says.
- Lie down on one side and stack your legs, knees and feet.
- Prop your head up on your bottom arm and place your top hand on your hips to make sure that your hips and pelvis stay stable.
- Keeping your legs straight and feet neutral, lift your top leg up as high as you can without shifting or leaning your hips.
- Pause and return to your starting position.
- Perform 2 sets of 20 on each side.
5. Seated Hip Stretch
This one is great for getting deep into the hip muscles and the glutes, and it helps you work on posture too, keeping your back straight and tall, says Pedante. This is a great one to do nightly to release any tension before getting into bed where you might stiffen up.
- Sit on the floor with your legs straight in front of you.
- Take your right leg and cross it over your left knee. Your right foot should be flat on the ground, with your knee bent.
- Take your left hand and gently hold the outside of your right knee, as you twist your torso toward the knee. You can look over your right shoulder as you twist.
- Hold your core in tight as well and only go as far as you can without feeling pain.
- Hold for 30 seconds.
- Repeat 3 times on the right, then switch legs.
6. Standing Hip Swing
This move is great for stretching out the inner and outer thighs in particular, says Flores. Since soreness in this area can strain the IT band, it's important to work on fighting any tension that can build up.
- Brace yourself on a wall or tree.
- Swing one leg out to the side, then back across your body.
- Let your hips move but try to keep the foot of the standing leg pointed straight ahead the entire time.
- Do 20 reps on each side.
7. Rear Foot Elevated Split Squat
This moves targets the glutes, hamstrings, abductors and hip flexors, says Flores. It also improves strength and balance in the lower body, so you you can avoid stressing your IT band.
- Find a bench or step about the height of your knees.
- Face away from it and bring one foot back and plant it on the bench. You can't be too far or too close, it may take a few tries to find what feels right.
- Keeping yourself as tall as possible, lower yourself down slowly.
- Pause at the bottom for one second, then return to the starting position.
- Make sure to keep your abs tight and avoid leaning forward excessively.
- Do 15 reps per leg.