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Understanding And Treating IT Band Syndrome

Understanding And Treating IT Band Syndrome

It can be rewarding to stay active, push our limits, or conquer new challenges. But what happens when a seemingly simple movement, like walking, cycling or running, becomes painful and difficult to do? IT band syndrome can be the culprit, causing symptoms that range from an ache at the side of the knee to a limp. It requires systematic assessment and treatment under the guidance of a healthcare professional to resolve the symptoms.

Keep reading to learn about IT band syndrome, its causes, symptoms, and most importantly, how to effectively treat and manage it to get back on track. For more information, reach out to our team at Ironhorse Physical Therapy & Pilates in San Ramon, CA.

What Is IT Band Syndrome?

Whether for an avid runner, cyclist, or just someone who enjoys a daily stroll, IT band syndrome can put a halt to health and fitness. The iliotibial band (IT band) is a long band of connective tissue running along the outside of the thigh. This band plays a vital role in stabilizing the knee joint during movement. However, when it becomes irritated or inflamed, it can lead to IT band syndrome, also known as ITB syndrome or Runner's Knee. Despite its name, IT band syndrome isn't limited to runners alone – it can affect anyone engaging in repetitive lower body movements.

What Causes IT Band Syndrome?

The journey from discomfort in the knee to IT band syndrome often starts with overuse and biomechanical factors. Imagine clocking in those extra miles during weekly runs or cycling without proper bike setup and form. These actions can create repetitive friction between the IT band and the underlying bone structures. Factors like muscle imbalances, improper footwear, and training errors can also contribute to the development of IT band syndrome. Essentially, anything that disrupts the harmonious movement of the IT band can lead to irritation and pain. This irritation or pain can be short-term, or it can become chronic and affect movements like running, cycling, or even walking. Just because the pain is centered at the knee, doesn't mean that's the root cause! We've worked with many runners and triathletes whose knee problem was actually coming from poor foot mechanics or an old ankle sprain or fracture that lead to decreased ankle mobility (which then caused the IT band to compensate). That's just one example but we also have many other examples of runners who had a hip or low back problem as the root cause of their knee pain. The trick is knowing or discovering the root cause - working with a health care professional 

Recognizing IT Band Syndrome Symptoms

IT band syndrome can create a range of different symptoms, depending on the extent of the injury and the person affected. It may also depend on how the injury occurred and other factors like past injuries, medical history, occupation, and fitness.

How Does IT Band Syndrome Feel?

IT band syndrome makes its presence known through a set of distinctive symptoms. Sometimes this means experiencing a sharp pain on the outside of the knee, especially during activities that involve bending the knee. Sometimes even for a normally pain-free activity like walking, suddenly IT band syndrome makes it hurt to walk. Walking downhill in particular can become uncomfortable, often prompting individuals to limp or alter their gait. 

Assessing The Severity

The severity of IT band syndrome can range from mild irritation to advanced inflammation. In its early stages, patients might notice a slight discomfort that subsides with rest. However, as the condition progresses, the pain can become more intense and persistent, affecting not only physical activities but also overall quality of life. Recognizing the severity of the symptoms is crucial in determining the appropriate treatment approach. 

Treatment And Management Of IT Band Syndrome

Treating IT band syndrome requires the right support. To manage and alleviate the symptoms of the injury, the first step is consulting a trained health practitioner, such as a physical therapist, who can assess the extent of the injury and prescribe the correct treatment. This helps minimise the risk of any side effects and maximise the positive outcomes of the treatment. 

Recovering from ITBS typically involves a multifaceted approach:

  1. Activity Modification: The first step towards how to fix IT band syndrome can be as simple as giving the body the rest it requires. Continuing to engage in activities that aggravate the condition can worsen the inflammation and delay recovery. But you shouldn't rest TOO  long ie. more than 3-7 days, depending on the severity of the symptoms. Resting too long will result in deconditioning and will take longer for the athlete to get back to running or cycling. The physical therapist may suggest modifying any exercise to include activities that don't strain the IT band, such as swimming, upper body workouits, ski erg or hip/core workouts . While these activities might not provide the same adrenaline rush as high-intensity sports, they'll help maintain cardiovascular fitness while allowing the IT band to calm down.

  2. Physical Therapy: A licensed physical therapist, like our expert team at IronHorse, can design a personalized rehabilitation plan to address biomechanical issues and muscle imbalances.

  3. Strength Training: Incorporate exercises to improve hip and gluteal muscle strength.

  4. Run Gait Analysis: Identifying and correcting running form issues can significantly reduce the risk of ITBS recurrence. Learn more about "crossover gait pattern" which can lead to IT band syndrome as well as our 3D run gait analysis services here: 3D Run Gait Analysis

  5. Gradual Return to Running: Slowly reintroduce running, monitoring your progress and making adjustments as needed.

Passive Modalities And Stretching

For those on the road to recovery from IT band syndrome, physical therapy can offer a range of different treatments to help. A trained therapist can tailor exercises to address the imbalances causing the IT band syndrome, such as massage, Active Release Technique (ART) and cupping. Additionally, targeted stretches to the surrounding muscles can provide relief.

Strengthening Exercises

Weak muscles can throw body mechanics off balance, contributing to IT band syndrome. Specifically targeting the glutes, hip abductors, and core muscles can help restore proper alignment and reduce strain on the IT band. The physical therapist can prescribe the best exercises, depending on dysfunction or weaknesses that are present. For example, incorporating resistance band exercises or Pilates routines as these focus on strengthening the core and stabilizing muscles – a valuable asset in restoring strength to the leg and knee.

Foam Rolling And Self-Massage

Foam rolling isn't just a trendy recovery practice – it can genuinely offer relief from IT band syndrome. Stretching and foam rolling the IT band itself is NOT very useful however and can often aggravate the syndrome or just doesn't help at all! There was a study done that attached 2000 lbs to the bottom of the IT band and it didn't change the length of the fascia much at all! The Glute muscles, on the other hand,  attach to the IT band and increase tension along it down to your knee. Consistency and technique is key to alleviate tension along the IT band-The controlled pressure to tits surrounding muscles with the foam roller can help release tension. Just remember, the key here is moderation – don't go overboard with the pressure, as excessive or aggressive rolling can exacerbate the irritation. For any concerns or doubt, speak to the physical therapist. Here's a video demonstrating how to roll your glutes that can help alleviate IT band syndrome: 

Cardiovascular Training with IT Band Syndrome 

It can be frustrating to get an injury and wonder “What cardio can I do with IT band syndrome?” While recovering from IT band syndrome might mean taking a temporary break from any usual high-impact cardio routines, it doesn't mean patients have to bid farewell to cardiovascular training altogether. There are plenty of low-impact alternatives that can help maintain cardiovascular fitness without exacerbating the condition. For example, the physical therapist may suggest activities like swimming, stationary cycling, and elliptical training which offer a fantastic way to keep the heart rate up without putting excessive strain on the IT band.

Precautions And Monitoring

When incorporating cardiovascular exercises, it's crucial to approach them with caution. Start slowly and pay close attention to the body's response. Any pain or discomfort should be discussed with the physical therapist, as it can be a sign to ease up or modify the activity. Gradually increase the intensity, duration, and frequency as your body allows. Remember, the goal is to challenge the musculoskeletal system while also respecting the body's healing process.

Long-Term Prevention Strategies For IT Band Syndrome 

Addressing The Underlying Causes

With progress and as the pain subsides, it's time to focus on preventing IT band syndrome from making a comeback. One of the key aspects is addressing the underlying causes that initially led to the condition. The physical therapist may complete a gait analysis to identify any movement abnormalities that might have contributed to the irritation when walking or running. The physical therapist can then help improve the movement patterns and ensure proper biomechanics.

Gradual Return To Activity

As tempting as it might be to jump back into a previous exercise routine, a gradual approach is essential. Even after recovery from the injury, the IT band might still be vulnerable to irritation. Gradually reintroduce higher-impact activities, monitoring the body's response at every step. The physical therapist can help determine when to progress or regress the activity. Additionally, it’s important to listen to any signals from the body, as if there are any signs of discomfort, it’s important to consider scaling back and give the body more time to rest and heal.

Maintenance And Self-Care

Maintaining a proactive self-care routine can go a long way in preventing the recurrence of IT band syndrome. Particularly with a past history of knee or lower limb injuries, regular stretching, strengthening, and foam rolling sessions can help to keep the muscles and connective tissues in optimal condition. However, pay attention to any signs of muscle imbalances and address them promptly with the help of the physical therapist. Staying informed about injury prevention techniques and staying in tune with the body's needs can also be a great defence against future episodes of IT band syndrome symptoms.

Get The Right Support To Fix IT Band Syndrome 

IT band syndrome might initially feel like a setback, but armed with knowledge and a comprehensive approach to treatment and prevention, it is possible to overcome it. Remember that seeking professional guidance is crucial for an accurate diagnosis and a personalized treatment plan. Whether modifying any normal activities, undergoing physical therapy, or incorporating low-impact cardio, the ultimate goal is to return to an active lifestyle without the burden of IT band syndrome.

Ironhorse Physical Therapy & Pilates understands that navigating the road to recovery after an injury can be difficult. Keep in mind that patience and consistency are allies, and our San Ramon physical therapy team can offer the support and guidance required for a full recovery. Healing takes time and we are here to support our patients every step of the way.

Why Choose IronHorse PT and Pilates? At IronHorse Physical Therapy and Pilates, we specialize in helping runners and triathletes like you overcome injuries and enhance your performance. Our licensed physical therapists and certified run coaches work together to provide a holistic approach to injury recovery and prevention.

Ready to Get Back on Track? Don't let IT band syndrome hold you back. Contact us today to schedule a run gait analysis and personalized physical therapy sessions. Our goal is to get you back to doing what you love – running and racing – stronger and more resilient than ever before.

Take the first step towards pain-free running by reaching out to IronHorse Physical Therapy and Pilates today. Your next PR (personal record) is within reach!

Contact Us: Call or text 925-222-5446 or go HERE to request a free phone consultation with a Doctor of PT who can help you get back to pain free running.


Physiopedia. Iliotibial band syndrome. Available from: https://www.physio-pedia.com/Iliotibial_Band_Syndrome 

Hadeed & Tapscott. (2023). Iliotibial Band Friction Syndrome. Available from: https://www.ncbi.nlm.nih.gov/books/NBK542185/ 

Runner's World. How to spot and fix IT band syndrome. Available from: https://www.runnersworld.com/uk/health/injury/a40675449/it-band-syndrome/