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This is Part 3 of 3 in a series on IT Band pain in runners! We already discussed the ins and outs of the ITB itself, what may be causing pain, and general rehab principles. Now we’ll talk about the most important part:

Returning to Running!

When returning to running after having IT Band (ITB) pain, it's very important to progress gradually. You'll want to make sure that you can tolerate loading and storing & releasing energy through that leg to ensure you’re ready to handle the demands of running. This is where a knowledgeable physical therapist can really guide you, ensuring that you’re ready to resume running and helping you navigate the progression back to your typical training plan.

Since walking mimics the demands of running better than any other cross training activity, I recommend it as a great cross training activity. This may be something you can do, depending on pain levels, throughout early and middle-stage rehab for two purposes: maintaining some fitness and continuing to load your muscles & joints in a manner similar to running. Uphill walking in particular (on a treadmill, to avoid downhills on the way home!) will both challenge the heart and lungs, and reduce strain on the IT Band while maintaining some level of running fitness.

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Once tolerant of uphill walking for 30-45 minutes, uphill jogging on a treadmill may begin with a gradual progression to flat surfaces. Oftentimes I’ll utilize a walk-run approach with my athletes to allow the body to rest a bit between running efforts while still increasing time on your feet. When flat surfaces are tolerated for 30 minutes with no or very low levels of discomfort, only then should you start to add in rolling hills or trails. Downhill puts a bit more strain on the IT band, so hills should be introduced gradually. As you return to hill training, keep your pace consistent - think of this progression not as a way to get your fitness back quickly, but as a way to ease back into running while avoiding the same issue down the road. Once rolling hills at an easy pace are feeling good for you, speed-work can be gradually re-introduced.

In addition to modifying the training surface, manipulating step rate can be very beneficial for ITB pain. Increasing your step rate by just 5% over preferred can decrease load on the knee by 20%! I recommend using the Run Cadence App to test this and then to increase your cadence - it provides you with a metronome to help you adjust to a new step rate. There are also apps that will sync music to your step rate, which can come in very handy.

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The most important thing is a gradual progression that changes only one variable at a time. This looks different for everyone, and it’s common for there to be some ups and downs along the way - progress isn’t linear. I highly recommend seeking guidance in this, as it can be tricky to know when to back off and when to continue. Reach out with questions regarding your ITB pain - I’m happy to help!

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