Can you show me some IT band exercises?

I teach patients IT band exercises on a regular basis. At our physical therapy clinic, we see everything from ultra-marathoners to the person who likes run a mile or two.

With all of these runners, I have seen a lot of iliotibial band (aka IT band) issues. I even experienced IT band syndrome myself about 14 years ago when starting a running regimen.

What is the IT band?

The IT band is a very thick band of fascia that runs along the outside of the thigh. It originates from the gluteus maximus and the tensor fascia latae. The gluteus maximus is the big muscle on your buttocks and the tensor fascia latae is a small muscle that attaches to the front of the pelvis. The IT band starts at the pelvis and runs along the outside of the thigh and attaches to the top of the tibia (the shin bone).

“Radiopaedia – Drawing Iliotibial band – English labels” by Matt Skalski, license: CC BY-NC-ND

What is IT band syndrome?

IT band syndrome is a sharp pain typically felt on the outside of the knee. It is occurs when the IT band rubs back and forth over the lower part of the femur. This causes inflammation in the area. It might also cause some compression of tissue in the area. IT band syndrome is an injury that results from activities requiring repetitive bending and straightening of the knee. In running terms the pain occurs when the foot on the painful side strikes the ground and the body weight is being transferred to the affected limb.

Symptoms of IT band syndrome

There are several symptoms associated with IT band syndrome.

Sharp pain on the outside of the knee
Increased pain with running or descending stairs
Snapping sensation over the outside of the knee can occur
Swelling on the outside of the knee
Will initially start having pain towards the end of a run or other activity. Will begin to hurt earlier and earlier as the inflammation gets worse.

Who gets IT band syndrome?

IT band syndrome is very common. However it mostly affects athletes or other very active people. As I have already mentioned, it is a repetitive or overuse injury caused from continually bending and straightening the knee. Common activities associated with IT band syndrome are running, cycling, soccer, rowing, and hiking. However it can occur with any activity that requires repetitive knee bending and straightening. It is also more likely to occur with increased time spent performing the activity. A long distance runner is more likely to develop IT band syndrome than the person who runs a mile or two a couple times a week.

Why did I get IT band syndrome?

There are several reasons why some of us develop IT band syndrome and others don’t. Some anatomical reasons include:

Hip muscle weakness
Tightness of the IT band
Running on uneven ground
Being bowed legged
Uneven leg lengths
Flat feet

Some training errors could also lead to IT band syndrome. These include:

Not warming up or cooling down long enough
Not stretching before workouts
Overtraining or increasing intensity too quickly
Running downhill or on tilted/curved surface
Not resting enough between workouts
Improper or worn out shoes
Poor running form or incorrect bicycle fitting

How do I get rid of it?

IT band syndrome is a painful nuisance and can become an obstacle for training or just going out for a nice jog. However there are several different things that you can do to calm it down and get rid of it.

Physical therapy – IT band syndrome is a condition that responds very well to physical therapy. Physical therapy is a great way to not only treat it but learn how to keep from coming back. PT can help decrease pain and swelling, lengthen the IT band, strengthen weak muscles, and analyze and improve your form. Most importantly a good PT will help deduce why it happened and how to prevent it from occurring in the future.
Ice – Ice is an anti-inflammatory which means that it can calm down inflammation. Since IT band syndrome is an inflammatory condition, ice can be helpful in calming down the pain. Ice the area with an ice pack for 15 to 20 minutes after sport or activity. If the area is very tender and painful, ice 2 to 3 times per day.
Stretch the IT band. There are several different stretches for the IT band. The video below goes over a few of them. Stretch the IT band before activity to help lengthen and then also after when the tissue is warmer and has more extensibility. Hold the stretch for 30 seconds and repeat it 3 times. See the video below.

Roll out the IT band – The IT band is a very thick band of fascia. It is not muscle so it does not stretch like muscle. This is one of the reasons that it can be difficult to stretch. I find that rolling out the IT band prior to stretching will help improve the tightness of the IT band. Roll on a massage ball or foam roller from the knee all the way to the hip. Also roll out the quadriceps (front of the thigh) and the gluteals (butt muscles). Spend a good 3 to 5 minutes rolling. Do not roll so hard that you bruise the area but it should be a pretty painful sensation. Roll out the area no more than a few times a week. See the video below.

Strengthen the gluteus medius – The gluteus medius is one of the gluteal muscle. It performs hip abduction and internal rotation which is taking the leg out to the side and also rotating it inward. However one of the most important jobs of this muscle is to keep the pelvis level when standing on one leg. If the muscle is weak, it will cause the opposite side of the pelvis to drop and also cause the knee of the standing leg to fall inward. This puts a strain on the IT band. If this occurs every time one strikes their foot when running, then eventually the IT band becomes tight. There are many exercises to strengthen this area. Having resistance bands is an easy way to add increased difficulty to the exercise. The video below reviews a few of them.

Change your form – If your gluteus medius was weak, and you have strengthened it, this does not automatically translate into better sport form. You have to actively change your form and think about activating the gluteus medius. This all has to do with movement patterns in the brain. The brain will automatically return to the old form even if your strength is better. You will have to intentionally think about activating certain muscles for a period of time until this becomes the new go-to motor pattern for the brain.
Figure out what you did in the first place – The best way to actually get rid of IT band syndrome is to figure out how you got it in the first place. Is it a muscle weakness, bad form, or a training error? Look back at when you started having the pain and what changed at that time. Did you get new shoes? Are your shoes too old and breaking down? Did you greatly increase mileage or speed? Did you start a brand new exercise regimen? Maybe you added too much too quickly. If you can figure out when and why it started, you can prevent it from happening again. If you can’t figure it out, your local physical therapist would be happy to help!

In review

The IT band is a thick band fascia that runs from the outside of the hip to right below the knee.
IT band syndrome is caused by the IT band moving back and forth over the end of the thigh bone.
The pain is on the outside of the knee and occurs when the heel of the affected leg strikes the ground.
IT band syndrome can be the result of anatomical factors and/or training errors.
IT band syndrome can be successfully treated with physical therapy.
Things that you can do include:
- Ice
- Stretching
- Rolling
- Strengthening
- Improving form
- Analyzing what went wrong and changing it