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Has IT Band pain stopped you dead in your tracks during a run? Have you been told to stretch or foam roll, but it just keeps coming back?

This is Part 1 of a 3-part series on IT Band pain. You’ll learn:

  • What it is

  • Why it happens

  • Why stretching and foam rolling aren’t getting you long-lasting results

  • Rehab suggestions to get you back to running

In Part 1, we’ll focus on what it is, and why it happens.

The iliotibial band (ITB) is a thickened portion of a structure called the fascia lata, a sheet of fibrous tissue that surrounds the thigh muscles. It runs from the hip to the knee, on the outside of the leg. The ITB is considered a tendinous structure, meaning that it's more similar in composition to your Achilles tendon than it is to your quadriceps muscles. Since it crosses both the hip joint and the knee joint, there are several different ways that ITB dysfunction can show up. We'll discuss the one that's most relevant to and common in runners. Classic ITB pain, or ITB syndrome, in runners presents as sharp pain on the outside aspect of the knee - the distal (further from the center of the body) insertion of the ITB. Pain is typically worse with walking or running downhill and is often so sharp that the athlete has to stop running, at least temporarily.

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There's been some differing opinions and proposals on what exactly is going on anatomically to cause ITB pain. The theories include friction of the band against the thigh bone, compression of the fatty tissue between the IT band and the thigh bone, and inflammation of the fluid-filled sac under the band.

Regardless of the anatomical details, it's important to understand that ITB pain occurs and recurs due to training load issues. If you quickly increase your mileage and/or suddenly introduce downhill running, you risk putting extra strain on the ITB that it's just not quite prepared for - leading to the potential for pain. Once that extra strain occurs, the ability of the structure to tolerate the load of running decreases further (especially if all you do is rest). So you can see how this can become a nagging injury for runners: you run, have pain, stop running, pain goes away, return to running quickly, pain comes back.

But wait...have you been told you have ITB pain because your hips are weak? Well, that may not be true. Studies have shown that those with ITB pain do have hip weakness, but those with hip weakness don't always have ITB pain. So it may be that ITB pain actually causes weakness in the hips or decreases activity of the hip muscles, rather than the other way around.

What about having ITB pain because your hip muscles are too tight? That also may not be true. Though the fascia of the gluteus maximus and tensor fascia lata muscles connect to the ITB, it's not clear that tension here directly causes ITB pain - like the hip muscle weakness, it's possible that ITB pain leads to feelings of tightness in the hip muscles.

So how do we go about improving ITB pain, if rest doesn't help, but it's too painful to keep running? Stay tuned for Part 2!

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