Understanding the IT Band and Managing IT Band Pain

What is the IT Band?

The iliotibial (IT) band is a tough, fibrous band of tissue that runs from the outside of your hip down to your knee. This fibrous tissue has both elastic and stabilizing features, explaining why we have an IT band at all. Its primary functions are:

1. Energy Storage and Release: During activities like running and jumping, the IT band stores and releases energy, making these movements more efficient.
   
2. Stabilization: It helps stabilize the outside of the knee, ensuring proper alignment and movement.

IT Band Anatomy¹

A stiffer and tighter IT band will store and release more energy, enhancing performance in activities like running and jumping and providing better knee stabilization.

What is IT Band Pain?

IT band pain is characterized by pain located on the outside of your knee. It is the second most common cause of knee pain in runners, and the most common cause of knee pain in trail runners. IT band pain is thought to be caused by the compression or friction of highly innervated adipose tissue that lies directly underneath the IT band where it attaches to the knee.

Common Myths and Causes of IT Band Pain

Common causes and risk factors of IT band pain are:

• Increasing running volume too quickly, especially running downhill and running faster.
  

• Running Form Faults: Faults such as crossover, pelvic drop, overstriding, and forefoot strike patterns can increase tension on the IT band, thereby increasing compression on the outside of the knee.
  

Myths:

• Failing to stretch your IT band
• Hip muscle weakness
• Leg length discrepancy
• Foot pronation

None of these factors increase the risk for IT band pain. The IT band cannot be stretched effectively; it requires over 2000 lbs of force to change its length³. Foam rolling, similar to stretching, does not change the flexibility of your IT band, it only adds more compression to the IT band, and can actually increase pain/irritation. Interestingly, a stiffer and tighter IT band actually performs its primary functions more optimally².

Differences in hip muscle strength do not impact whether an individual will develop IT band pain with excessive running. However, strengthening the hip is beneficial for rehabilitation, as IT band pain can cause muscle imbalances, including hip weakness, in the injured leg. This is a symptom, not a cause, of IT band pain⁴.

Leg length discrepancy and foot pronation do not change the tensile force of the IT band and, therefore, cannot increase compression at the knee².

What Can You Do About IT Band Pain?

Stretching or rolling your IT band will not get rid of the pain. Instead, work with a physiotherapist to address the underlying issues. A typical rehabilitation program involves three phases: Pain Management Phase, Progressive Loading Phase, and Return to Running Phase.

By understanding the structure and function of the IT band, as well as the true causes of IT band pain, you can take proactive steps to manage and prevent this common runner’s ailment. Remember, proper training and running form are key to maintaining healthy knees and avoiding IT band pain.

Are you currently experiencing knee pain? Wondering what could be causing your knee pain when running? Book an assessment with us to find out what it is and what to do about it.

References:

1. https://www.physio-pedia.com/Iliotibial_Tract#/media/File:Iliotibial-band-itb-anatomy-diagrams.jpeg
2. Physio Network: Iliotibial Band Pain: practical strategies for treating runners – Masterclass
3. Chaudhry H, Schleip R, Ji Z, Bukiet B, Maney M, Findley T. Three-dimensional mathematical model for deformation of human fasciae in manual therapy. J Am Osteopath Assoc. 2008 Aug;108(8):379-90. doi: 10.7556/jaoa.2008.108.8.379. PMID: 18723456.
4. Grau S, Krauss I, Maiwald C, Best R, Horstmann T. Hip abductor weakness is not the cause for iliotibial band syndrome. Int J Sports Med. 2008 Jul;29(7):579-83. doi: 10.1055/s-2007-989323. Epub 2007 Nov 30. PMID: 18050060.