This is part 2 of 3 on ITB Pain in Runners. This will focus on:

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• Why it happens

• Why stretching and foam rolling aren’t long-term fixes

• What to do to instead to get you back to running

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Since the ITB is a tendinous structure, it requires a certain amount and type of load (exercise) to get stronger and allow you to tolerate running. The right amount of loading is going to vary between individuals, so I recommend seeking guidance from a healthcare clinician familiar with running. However, a few general principles for rehab remain the same.

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First, reduce or eliminate the stretching. Your IT Band actually plays a role in stabilizing the outside of your knee - so it’s a good thing for it to be tight! Likely complementing its role in knee stability, the IT band is nearly impossible to stretch. It's pretty much anchored down to the thigh bone, and is very tough and dense. It’s true that it can feel tight - that’s a real thing, but it might be feeling that way because it’s not tolerating the work required of it, not because it needs to be stretched. Not only have studies shown that it’s very difficult to stretch the IT band but also that any attempts at it are unlikely to prevent or ease pain. Finally, in addition to all that, if we circle back to the possibility of IT band pain as a compression injury, stretching may only serve to further irritate the painful area.

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Second, let's talk about foam rolling. Using a foam roller can improve flexibility and range of motion in the short-term, but it's not going to get your tissues to adapt to the forces of running. The foam roller just won't cut it as a long-term fix for ITB pain. With that said, it’s not likely to be harmful - so if you like it, go for it! I just recommend that you avoid rolling directly on the irritable area of the knee - again, compressing it further with a roller will likely just irritate it. Foam rolling closer to the hip (side of the hip, butt muscles) can help reduce feelings of tension and discomfort, but again, this relief is only temporary. I recommend putting your rehab efforts into more effective solutions that involve loading the tissue with exercise.

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Finally, the fun part - loading!! I can't stress this enough - if exercise isn't a major component of your rehab program, there's a good chance that the ability of your ITB to tolerate running will continue to decline.

So what does this loading look like? Even though hip weakness is not a direct cause of ITB pain, it appears that working on hip strength and control helps to resolve it.

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What follows are some suggestions for ITB rehab exercises in 2 stages (Early stage = still fairly painful to walk downhill or down stairs. Late stage = able to walk downhill & downstairs without pain)

Early stage: short lever SL bridge hold, side plank hold on knees, slow rear-foot elevated split squat