IT Band Pain? Don't Roll It. Do This Instead

If you've heard of the iliotibial (IT) band, it's probably in terms of iliotibial band syndrome (ITBS), which commonly causes knee pain for runners and cyclists. But if that's all you know about the IT band, you're missing out on some important information for injury prevention and treatment.

When it comes to treating and preventing IT band pain, if you're relying on foam rolling the length of the IT band, here's why you should stop — and what you should do instead.

Also clinically known as the iliotibial tract, this important band of connective tissue runs half the length of the leg from the hip to the knee. It's made up of layers of dense connective tissue, known as the fascia.

Understanding the composition of the IT band is paramount to debunking one of the biggest myths about it: You can't have a tight IT band, says James Gallegro, PT, CSCS, clinical specialist in the Sports Rehabilitation and Performance Center at the Hospital for Special Surgery.

Because the IT band is so tough and thick, it can't be easily deformed, says Nick DiSarro, PT, DPT, a physical therapist with ResilientRx based in Austin, Texas. In fact, DiSarro points to an August 2008 study in the ​Journal of Osteopathic Medicine​ that found it takes roughly 2,000 pounds of manual pressure to deform the IT band. In other words, your IT band can't be stretched (or tight).

This isn't to say that if you're experiencing pain or tightness along the IT band that it isn't involved; it could be leading to tightness in surrounding muscles or tissues. DiSarro uses ITBS in runners as an example, citing that it's likely coordination problems that are leading to tightness they feel.

"Muscles like the tensor fascia latae (TFL) and gluteus maximus work to decelerate the leg every time it swings it forward when running," he says. "If these muscles are not functioning properly, it can cause the IT band to excessively compress the tissue underneath it. This repetitive motion, over time, is what leads to pain."

Because the IT band itself can't be stretched, it's likely time to change up your stretching and foam rolling routine. Rolling up and down the length of your IT band isn't going to have any effect on the IT band itself.

"Fascia is actually by design quite resistant to stretching; it is meant to transfer load," Gallegro says. "Muscles can be stretched, but fascia not so much." And a June 2021 study in the ​International Journal of Sports Physical Therapy​ supports this, noting that neither stretching nor foam rolling affects stiffness along the IT band.

"Foam rolling can create a temporary analgesic effect because it's a novel stimulus to your body's nervous system," DiSarro says. "This can result in a short-term decrease in tone (or muscle guarding) and cause temporary increase in flexibility or simply 'feeling looser.' What it does not do is improve mobility, break up scar tissue/knots/adhesions, or length/loosen the IT band."

If foam rolling and stretching your IT band won't do anything for your pain, then what should you be doing? Don't throw out the foam roller just yet — you can still use it — and make sure it's one small part of a larger approach to the surrounding muscles and structures.

As with any injury, as soon as any pain or discomfort pops up, it's time to modify your physical activity until the pain resolves or you get a proper diagnosis or treatment plan.

DiSarro says this may look like cutting back on mileage or modifying your workout regimen to focus on strength and flexibility exercises (see below for more on those).

Water makes up the majority of the volume of fascia, according to a January 2012 article in the ​Journal of Bodywork and Movement Therapies​. That means fascia relies on hydration to stay healthy.

"If someone is under-hydrated, the fascial layers will not be able to slide and move on each other freely," Gallegro says. "When the fascia is under constant tension, the makeup of the tissue stiffens, preventing that normal slide and glide."

While you can't stretch the IT band, you can stretch the muscles around it. Gallegro specifically recommends focusing on stretching the TFL and gluteus maximus. Options include a seated spinal twist, iron cross stretch and standing glute stretch.

​Move 1: Seated Spinal Twist​

1. Sit with your legs extended out in front of you.
2. Bend your right knee up toward the ceiling and cross your right foot over so that it rests outside your left knee.
3. Cross your left arm over and use it as leverage to twist to the right. Your left forearm should press into your right thigh.
4. Hold for 30 seconds before untwisting and repeating on the other side.

​Move 2: Iron Cross Stretch​

1. Lie on your back and extend your legs to the ceiling with knees bent at 90 degrees.
2. Stretch your arms wide at your sides ensuring your shoulder blades, spine and palms are all in contact with the floor.
3. Slowly rotate your knees from side to side, keeping shoulder blades pinned to the floor to challenge your postural muscles.

​Move 3: Standing Glute Stretch​

1. Stand tall and cross your left foot over your right knee.
2. Sit your hips back and use your left elbow to press your left knee down slightly to deepen the stretch.
3. Hold for 15 to 30 seconds before doing the same on the other leg.

As noted above, strength and flexibility exercises should be a focus when dealing with pain around the IT band.

"The idea is to incorporate lateral hip strength and lower-body stability drills through movements that improve proprioception (the ability to sense and be aware of body position) and neuromuscular control (the unconscious response of the body to maintain stability)," says Aaron Horschig, PT, DPT, CSCS, owner of Squat University and author of ​Rebuilding Milo​.

He recommends assisted single-leg squats, lateral band walks and single-leg Romanian deadlifts.

​Move 1: Assisted Single-Leg Squat​

1. Stand in front of a chair or couch.
2. Raise your right leg straight out in front of you.
3. Rooting your left heel, press your hips back and sit down into the chair slowly, keeping your back flat.
4. Tap the chair with your butt lightly, then press into your left heel and reverse the motion to return to standing.
5. Once you finish the time on this leg, switch sides.

​Move 2: Lateral Band Walk​

1. Place a mini band around your ankles and stand with your feet hip-width apart.
2. Slightly bend your knees and lower yourself a few inches into an "athletic stance."
3. Step to your right side with your right foot.
4. Step your left foot toward your right to return your feet to hip-width apart.
5. Keeping your knees bent, take several steps to the right.
6. Repeat this motion moving to the left.

​Move 3: Single-Leg Romanian Deadlift​

1. Stand on your right leg while holding a dumbbell at your side in your right hand.
2. Keeping the right knee slightly bent, perform a stiff-legged deadlift by bending at the hip, extending your free leg behind you for balance or resting the top of your foot on a bench.
3. Continue lowering the dumbbell until your upper body is parallel to the ground, and then return to the upright position.

Here's where you need that foam roller! DiSarro recommends spending time rolling your glutes, TFL and quads for shorter periods of time — "less is more!" he says — to help loosen things up.

If you do choose to foam roll, Horschig warns that you should never roll over painful spots on the lateral part of the knee. "Extreme compression on that area of inflammation (where the IT band attaches) could exacerbate your symptoms."