Sock Doc Video: Treatment & Prevention of ITB Syndrome

Video Transcript

Hey, this is the Soc Doc, and today I’m going to talk about a common injury. It’s called iliotibial band frictional syndrome, also known as ITB syndrome. It’s pain on the outside of the leg, most often in a runner’s knee. It’s like an ice pick sticking in the outside of your knee, a really tough pain to be dealing with. Most runners have it for many months, sometimes even a half a year, where they can’t run, or they’re hobbling home after a short little run. It tends to get worse and worse. Unlike planar fasciitis, which I talked about in my last video, which tends to get better as you walk on it, usually, the iliotibial band frictional syndrome, that pain only gets worse the more you use it.

So iliotibial band is actually a band of fascia that comes down the outside of your leg here, and attaches to the outside of your knee. That’s most often where the sharp pain is, like an ice pick. The iliotibial band is an extension of two muscles. One is the tensor fasciae latae, which is up here on the side of the hip. The other one is the glute max muscle, which is your powerful butt muscle that comes all the way down and actually intertwines with the hamstring, here. About three-quarters of the way down your leg, the connective tissue is. So with your tensor fasciae latae up here, and your glute max, those fibers come down and wrap around, and make up your iliotibial band. Basically, the iliotibial band, it’s right around 25 percent of the tensor fasciae latae, and another 75 percent of your glute max. That’s what many people disregard as the power in their glute max, and that fiber, those bands coming down and making up the iliotibial band.

A couple things you want to look for, for iliotibial band issues. One is you don’t want to ice it. Ice just tends to tighten up the iliotibial band. We don’t want to do that. Sometimes warmth will work, at least to get you over some general symptoms. It’s not going to correct the problem. We’re going to get more into that in a second. The other thing you don’t want to do to the iliotibial band is stretch it. When you injure a muscle or fibers, in this case, the fascia, you want to keep those connective tissue muscle fibers joining back together to one another. The more you stretch something, the more you elongate it, the further you keep the injury going. You’re basically going to prolong the injury the more you stretch something, especially the iliotibial band.

What are we looking at for the IT band? One is you might have an issue in that TFL. You might have an issue in the glute max. Couple things you can do is look for trigger points in there. See if there’s any tender spots in the iliotibial band, or any tenderness coming down the glute max, obviously on the same side, as it wraps around into that final insertion point in the iliotibial band. You don’t want to mess around with the iliotibial band. Stay off the band, especially the insertion point. It’s just going to cause more pain. So you’re looking to treat the muscles that make up the band, not the actual band itself. The second thing you’re going to look for is any problems with the lower leg. Look for trigger points on the inside of the tibialis posteri muscle, behind the tibialis, like I showed in the planar fasciitis video. Also look for any tenderness down in the shin muscle here, your tibialis anterior. Very commonly people get shin splints. So that’s another area to look at. A third area to look for tenderness, is the inside of the knee here. What happens is, I’ll show you on this side, there’s three important muscles that attach to the inside of the knee. When one, two, or even all three of these muscles fatigue, what happens is the muscles on the outside, and now a major part of the iliotibial band insertion, that spasms because of the weakness on the inside. You get an imbalance between the inside and the outside of the knee. Three muscles that attach right here on the inside of the knee are all related to your adrenal glands.

When someone’s under a lot of stress, that means anaerobic workouts, training at too high a heart rate, racing too much, someone who’s under too much mental or physical stress. They’re pushing themselves too hard, there’s family issues, there’s work issues. Those muscles are actually a very good reflection of how much hormonal stress you’re under. Even a poor diet will do it. A diet with hydrogenated fats in it, MSG, too much refined sugars, will actually affect the muscles of your knee, and these inner knee muscles here that support your joint. Then you can end up with a spasm in that band as it tries to support the area. So a big key point here is that the iliotibial band is a reflection of other things off in your body, in this area, and it’s trying to support the problem. So we’re not going to fix the iliotibial band by fixing it directly, but by addressing the root cause of it. In this case, if you have tenderness right in that area, it could very well be because you’re under a lot of stress, and it’s an adrenal gland issue.

The fourth area we’re going to look at is gait. What happens is, if she had an iliotibial band issue on this side, every time she steps forward with her right leg, these muscles in the front of the thigh should be firing. In a normal gait position so should the muscles on the upper body, on the opposite limb, so this arm muscle. As these work, these work in harmony. As you switch your gait to this leg, as this leg goes forward, the extensor muscles on this side, so her glute max now on the right side, as well as the triceps on this side, are also firing. That’s how someone normally walks. Let me do it correctly. Like this.Extensors on the opposite sides are firing in regards to your lower leg muscle and your upper arm muscles. So triceps and glute max, here, on this side, and here, and then flexors on the upper body, and flexors on the lower body, on the leg that’s forward. So she steps forward. If she was having an iliotibial band on this side, as she steps forward, and these muscles aren’t supporting her well, maybe her tensor fasciae latae is a flexor, making up part of that iliotibial band. That could be because of a flexor problem, maybe a bicep problem, maybe a shoulder problem on the opposite side. Or the extensor problem, if it was her glute max, which makes up 75 percent of that iliotibial band, that could be fatiguing on her because of an extensor problem on this opposite side. Maybe in the triceps, back of the shoulder, or that area. She actually needs to be looking to treat this area. Maybe there’s some involvement up there. Maybe there’s some imbalance that she could investigate with her therapist or doctor. Don’t disregard the gait. It’s a big deal. So that’s three areas. We’ve got the local muscles again, tensor fascia latae, we’ve got the glute max, that’s considered one, two is the inner knee muscles. If it’s an adrenal gland issue it might be tender there. Three is the lower leg muscles to support the knee joint. Four is the gait imbalance. Five is actually the foot muscles.

The strength of the feet, like I talked in the planar fasciitis video, is very important for your gait. Very important to support the rest of your body, pronation, shock absorption. Go barefoot as much as possible, like I’ve always preached. Stay away from those orthotics. The more you wear orthotics, the more you’re going to fatigue your feet, throw off your gait, and eventually end up with a problem. It could be an iliotibial band problem. It could be planar fasciitis. It could be a shoulder muscle problem from the way that you’re throwing your gait off. Think minimalist shoes, too. She wears Nike Frees 3.0. Pretty good minimalist shoes. Lots of others out there. Remember when you’re buying shoes, keep them nice and level. Not much of a drop, not much of a heel on them, and you should be able to bend them in any direction. Good old Nike Frees have grooves in them. There’s the rock stuck in there. You should be able to turn them and twist them in any direction possible, and a nice light toe box for the toes to splay out. When you’re not wearing shoes, try to be barefoot as much as you can.

Watch the feet. Look for the adrenal gland issues. Look at those other muscles that you probably haven’t considered before. No icing. It’s just going to tighten that IT band up more. No stretching. It’s going to irritate the fibers and elongate and stretch them, and stretch out the length of your injury. Look at the opposite gait. Don’t forget about that glute max importance, especially if you’re a cyclist or a runner. It’s pushing up hills. Big muscle to use. That’s it. Thanks for watching.

ITB Syndrome is a common and quite painful leg/knee injury that can leave runners, triathletes, and even cyclists out of commission for months.  It often presents itself as pain on the outside of the leg, typically near the lower part of the knee. In this video Sock Doc discusses the reasons for ITBS – muscle imbalances, anaerobic excess, improper footwear -  as well as  treatments you may want to consider, including those you should avoid such as icing, stretching, and orthotics. Read more about Iliotibial Band Syndrome.

Comments

  1. Great video thanks!! I posted a comment in the forum about my own IT band problems.

  2. Very interesting and definitely gives me some things to think about….never considered the opposite limb as a possible issue and never before heard of the adrenal gland affecting the triad of muscles in the knee. Thanks for posting this and thank you for your response to my questions on the forum.

  3. Thanks for the video. I have had several problems all on the left side of my body from running in minimalist shoes and a little barefoot. Right now, I am sidelined from running due to IT band.

    A few months ago this all started with a calf strain from running in the Saucony Mirage. I did something really stupid and ran 4 miles on balls of my feet, I did not let my heel land. I could barely walk for a week due to DOMS. My left calf took months to completely stop hurting, but I did run and actively manage it as it healed. I started doing a lot of my miles in a 10 MM drop shoe (Mizuno Elixir). As my calf was healing my hip flexor (same side) began to hurt. I went to doctor for the hip as I wanted a picture of the joint spaces, fortunately all was fine.

    I cut back on the minimal shoes and actively managed the hip pain and it seems good now as does the calf. Then, while doing most of my miles in the Elixir’s, I developed top of foot pain. Some mornings I could barely put my foot down. But again, I was successful at actively managing that issue by running on a limited basis. No doc involved this time. Now, about a week ago, I went for a long run on a cambered road and I had to limp home due to my IT band.

    I feel hopeless about running minimal now, or barefoot. I stopped the IT stretches and foam roller directly on the IT band. I don’t know where to go from here. The video seems very complicated looking at every part of the body as a cause. What about treating the out of balances? Do we strengthen hips, butt, or what?

    Thanks!!

    • To correct the muscle imbalances you have to address where those imbalances are, and you cannot correct them by exercising the “weak” muscles more and stretching the “tight” muscles. Yes, sometimes it can be very complicated but I tried to address the most common areas of treatment for the ITBS. So check for trigger points in the glue max and TFL as I show in the video. For you also look at the calf strain you got a few months ago – that may still be affecting your gait.

      Once the injury is healed (pain gone) the best exercises for the hips and lower back other than running/walking I feel are Kettle Bell exercises – primarily hip swings, deadlifts, and deep squats.

  4. Megan Zetter says:

    Good stuff! Thanks for your work Sock Doc

  5. I’ve been fighting ITBS since Sept 2009. I was training for my first marathon (still haven’t ran one because of this injury) and after my first 20 mile run, the ITBS set on. I could not get rid of the pain no matter what I did. After watching your ITBS video, I noticed that anytime i worked on my leg strength (glutes / hip abductors) and lower back / core exercises, I can once run again comfortably up to about 10 miles. I fluctuate between 5-10 miles without pain, but I cannot keep the ITBS pain away. I do play soccer 2-3 times a week. I love soccer, but I also love to run. I was wondering if you have any other ideas that I could pursue to completely remove the ITBS. I would like to start running races again. I had to stop because of the injury in 2009. I have only been able to run 3-6 miles at a time to train for soccer. Before the injury, i could easily run and play soccer. Now it looks like I have to choose one or the other, which I’m not willing to do.

    In order to increase my mileage, I’ve been doing the following:

    1. Lunges for my Glutes
    2. Hip abductor strengthening
    3. Quad extensions
    4. Leg Curls
    5. Groin strengthening

    I do these 2-3 times a week depending on my workout / soccer / running schedule

    I developed lower back pain last year and I do the following:

    1. Lower back exercises for lower back pain – this has worked…my back is much better
    2. Stretching my core – I know you say this does nothing but all physical therapists i’ve been to has told me to do it…I need to understand more why i shouldn’t stretch (I don’t feel comfortable not doing it)

    Any help / thoughts would be greatly appreciated. I need to run the tough mudder in Ohio on April 14th.

    Thanks,

    Mike

    • Hi Mike, you’re going into 2 1/2 years of being injured with ITBS, and you’re looking to race in less than one month – that’s tough to give personal advice on with a history like that. Ideally you need someone to work on you and figure out why you have so many muscle imbalances resulting in ITBS and low back pain. Though the strengthening of those muscles may help some, exercises like that don’t facilitate (turn on) muscles that are inhibited (neurologically weak) resulting in your injuries & pain.

      Stretching – the reason you don’t feel comfortable not stretching is because of the many muscle imbalances you have. If all your tendons, joints, and muscles were working efficiently and in balance with one another you’d see no need to stretch. I explain this in more detail in the Stop Stretching! post. Of course you NEVER want to stretch injured muscles you’ll just prolong the injuries – and they’re already very prolonged.

      Perhaps your training intensity or duration is an issue too but from my experience what I see is that when someone has an injury for so long they’ve created more and more compensations as they walk, run, and move inefficiently and un-naturally every day so treatment is the best way, and sometimes the only way, to fix this stuff. The honest truth here is that a 2.5 year old injury is a long time, and you can easily tack on several more months before that because you don’t just “wake up” with ITBS one day – it develops over time.

      • Hi,

        What / whom do you recommend I go see? I’ve been to an ortho who told me stretching / yoga / strengthening was the answer. I’ve been to physical therapy and sports massage. The massage helped to loosen my back pain, but it did come back. I know i have alignment issues and imbalances because my right leg tends to get tight and “shorten” causing right hip pain. I have remedied that by strengthening my hips / stretching. It comes back from time to time…

        I’m sure i’m compensating for other issues…

        I live near Flint Mi….

        Thanks!

        • That’s the tough question that I get a lot Mike. I don’t have a reliable referral base, sorry. Not too many docs will spend 1-2 hours with a patient to go through the entire body/injury to sort it out, test it (in your case running) and see what fails to figure out why, fix it, and then correct it.

  6. Finding trigger points as shown in this video as well as in others are sooo helpful. I tried the same technique on two sore trigger points under opposing sides of my jaw and the muscles relaxed and went back to their natural position. My esophagus was less tight because the muscles that criss cross in front were relaxed and my breathing improved significantly. Thank you for you videos the principle of “erevything is interconected’ helped me work on other triger points on my leg and helped my PF. 2 podiatrist could not figure out what I had. Seems like they were guessing at my the source of my condition.

  7. Dr Robert Shackleton says:

    Hi Steve, Check at 5:25, you are describing contralateral function but are demonstrating
    homolateral movement. I had typed a longer message but the captcha code deleted it.
    Perhaps we can talk.

    • Yes I know. It’s not really either as I was “talking and walking” at the same time and kinda confused myself in the process and then just moved on. Thanks :)

  8. Hi Sock-doc!

    About two months ago i got an injury when I played a soccer game, a guy slammed his knee in the side of my left knee, I was sore for a couple of days but then the pain disappeared, but whenever i go out for a run, low HR, after about 10-15 minutes I start to get pain in the outside of my injured knee, and the pain sounds similar to itbs pain. I can walk, train with bulgarian bag, train kick-boxing without any pain, I can even run short bursts. The pain only come when I try to run longer. Is it possible to get a itbs problem from an impact injury like this? Or is it just an coincidence?

    I might add that I’ve struggled with a lower back stiffness when waking up, after I attended a movnat workshop in the end of august.

    (I try to eat healthy most of the time meaning organic food paleo style and I take vitamins, omega3, d3, magnesium on a daily basis)

    Best regards,
    Patric

    • Sure you can get a problem from an impact injury like that; I’ve seen it in the soccer players I treat. Might be a connection to your low back problem – the ITB and that injury playing off each other. So check out the low back video too, maybe have someone who knows a lot about the body check you out.

  9. Thank you for the video.

    I went running 10 miles yesterday (on minimalist shoes) and area is very hilly. Never would I have thought that my bad shoulder may have influenced my bad gait yesterday: pain on right ITB, bad left shoulder.

  10. Hi,

    I’ve watched your video and also read the stop stetching article. At the moment I’m suffering with my ITB and I also go through phases of stretching, general stretching hamstrings, back etc not ITB specific stretching. Could stretching be a contributing factor for my injury??

  11. Jacqueline says:

    Hi Doc,
    I was diagnosed with ITB syndrome about 6 months ago. I went through Physical Therapy twice a week for about three months. I was icing, stretching and doing strengthen exercises. So basically, I was doing all the things that you recommend we DON’T do. I was also using an ultrasound and rolling my lower legs. I had a lot of tightness on my lower legs and back especially after working out and at night. At first the therapy seemed like it was helping, but the pain would come back and I notice that I was not really healing.
    So I stared searching for some time of help. I came across your website about a month ago. I love your website. I’m very excited and hopeful that this could make difference for me. I’ve stopped stretching, icing, I don’t use the ultrasound and I have also stopped doing the strengthen exercises for my hips. I started doing the trigger point therapy on my lower legs. I do swim to keep active and I do feel some discomfort after I swim but not like I felt 6 months ago.
    Since I’ve been doing the trigger point therapy, I’ve notice some improvement but I am not completely healed. I still feel some pain on the side specially after running to catch a bus or train. Which I avoid doing but can’t always. It’s a burning sensation and it is not as sharp as it used to be. I have improved and maybe I’m just impatient.
    I am looking to hopefully be healed by spring. I like to cycle but I had to stop when I developed ITB. I have been less active for fear of irritating the knee. Do you have any additional recommendation? Is there anything else that I could be doing to help the healing process? Can ITB heal completely?
    Thanks so much for your help Doc

    • Hi Jacqueline, Glad to hear you’re improving. Yes you can heal 100%, especially the ITB. Sometimes when you’re injured for so long you lose hope, but your body can heal.
      Check out the Sock Doc Injury First Aid and the Trigger Point post for more of what you’re looking for.

      • Jacqueline says:

        Hi Doc,

        Thanks again for the great info. Is just so helpful to have a better understand. Thanks so much for all your help.

        I was wondering…do you think I could start weight lifting (bands, light dumbbells) for toning my upper body, or maybe yoga or swimming. Ideally, I would like to try indoor cycling for cardio, but I don’t know if I’m ready and I’m afraid to back track on my ITB progress.

        What are your thoughts Doc?

        Thank you

  12. Hi Steve,

    I have a similar but not identical problem in that I experience persistent one sided hip pain when running which seems to be caused by a gigantic trigger point in the glute medius. I have also found that my IT band seems to ‘twang’ over the greater trochanter on the same side if i shift into certain positions so although I have no knee pain, I suspect it isn’t too happy either.

    I keep working on the trigger point and I am trying to strengthen my abductors but I was wondering if you have other tips which may be relevant to my particular issue but not mentioned on the video?

    Do you think something like that would be mostly caused by abductor weakness or could you suggest anything else that could be involved from a biomechanical perspective? I’m already using minimalist footwear and following lots of your other advice on diet and lifestyle.

    Your site is a fantastic resource and basically a one stop shop for all of the types of things i’m into. I’ve become heavily reliant on it!

    Thanks

    Andrew

    • Thanks Andrew. Yeah I try to give general advice here which will hopefully help most people. But it will definitely not help all. In my office I end up treating each individual case of any injury, even ITBS, differently. Sometimes I never even have to treat a glut med/TFL/or glut max trigger point. Check out my Trigger Point article if you haven’t already to understand why they are there and may always return.

      • Thanks for coming back to me. Don’t get me wrong, your advice definitely is helping the problem I was just wondering if there were ways in which I could taylor it to account for the fact that my presentation is a little different to the one described here. I guess that’s difficult to do without an examination

  13. runnerdude says:

    This is definitely making a lot more sense to me. My ITBS is still lingering around. The worst pains stopped long ago and I am able to run/do elliptical/bike around 40 minutes without pain, but after multiple days in a row (not recommended I suppose) the pinching feeling comes back to remind me it’s still there. Sometimes the pain is around the fibular head, sometimes slightly above that by the actual joint, and sometimes on the front of the knee. The bizarre achilles tendon pains are gone for whatever reason. Also unfortunately I will get a bruise around any of those knee areas whenever the pinch returns.

    So this post is making a lot more sense, especially when you talked about muscle imbalance. I do not think my hips or glutes are really that weak, I think actually that they are stronger than my upper body in general. But the upper body muscles on my left side is weaker overall than my right. All the arm muscles on the left side always struggle a bit with a heavier weight at the gym so I have focused on lower weights to try to help the left muscles catch up. This overall imbalance may very well be the problem causing more strain on my right knee.

    A lot to consider. I wonder if there are any doctors in my area that focus on this kind of treatment you write about.

    • I’m all about making sense. :)

      Look for a doc/therapist who evaluates and treats the entire body and doesn’t just stare at your knee.

  14. Hi Sock Doc,

    Like many others have said, I find that your approach to ITB syndrome seems very contrary to what I’ve heard in the past, and may explain why so many of us go so long without a cure – and like others I really appreciate the fact that you take the time to reply to questions!

    I hadn’t seen anyone post a story that started quite like mine and wondered if you had any input. First some quick background. I was really active growing up, running and playing basketball up until around the age of 17. From about that time, until around the age of 26 I was very inactive, working full time, going to school, I didn’t make time for exercise. At the age of 26 (back in Aug 2009) I enlisted in the Army. By the end of basic training, I was running a 13 minute 2 mile, and felt great! I figure if your going to get an overuse injury, that is where it would have happened! After basic training, the day prior to getting to my next duty station I had gotten really sick. After a few days at my next duty station, I eventually was taken to the E.R. and diagnosed with a temp of 103.6 and pneumonia (worst I had ever felt!). I was treated with antibiotics, and recommended to rest for a couple days.

    About 2-3 weeks later, during my first physical training test during the 2 mile run, I started feeling a sharp pain on the outside of my right knee. Over the next week or 2 I had pain on the outside of both knees, and the areas you mention on the outside of the hip. I also developed pain in my lower right glute. The Army’s treatment for most soft tissue injuries are stretching and NSAID’s, in fact, I was given both Ibuprofen and a oral steroid, which only seemed to make things worse!

    It wasn’t until about 2 years later that I had been doing research on chronic tendinitis (tendonosis) that I found links to quinolone antibiotics (Levofloxacin) and tendon injuries/ruptures. The primary onset of injury lined up exactly with my injuries after taking the medication.

    My question now is what to do about it – nearly 3.5 years later, I’ve almost given up and lost all hope! I’ve done physical therapy, which included “scraping” or Graston technique and stretching which was extremely painful and seemed to only temporarily help the problem. Being in the Army I don’t have many treatment options. I’m just curious if you’ve had patients with injuries related to quinolone drug use and if so have they been able to beat this thing?

    Thanks!
    Tom

    • Yeah you can definitely heal up from this but those drugs affect people’s tendons in different ways so it’s hard to say “do this”. So you treat it as you would any other injury as I show in the videos but if you don’t respond it’s because the connective tissues are weakened — see my article on that “GAGS Synthesis”.

  15. Once I locate the trigger points what exactly should I do and how long should I work each one. I have had ART therapy done for other issues in the past but trying to do some self treatments due to costs but I know it’s hard to work these trigger points out yourself ! :)

  16. Hi Sock Doc,
    Hope you’re still monitoring these posts. I have been experiencing ITB issues for a few weeks now. After watching your video, I checked the areas you mentioned and notice tenderness/pain on the inside of the knee. In the video you don’t point out possible trigger points for this but you mention that this can be connected with Adrenal gland problems. Can you elaborate on what can be done to correct the Adrenal gland? Thanks so much for the great information you provide!

  17. How do you rehab4 weeks post ACL and deal with ITBand Syndrome at the same time? I have to ice the knee, yet I’m not suppose to ice the ITBand. Yikes, this is a nightmare. Any suggestions??

  18. And how’s it working out for you?

Trackbacks

  1. [...] to. I was whining to my neighbor Bobby about my inability to run without pain and he e-mailed me a video on the treatment and prevention of the IT band by the Sock Doc. The Sock Doc went against everything I had read or been told about treating IT [...]