If you’ve had Iliotibial band (ITB) Frictional syndrome, then you know how much it hurts, and how it feels like it’s never going to go away. I’ve had it more than once many, many years ago before I knew how to train and eat properly. It’s one of those pains in your knee or the outside of your leg where you go out for a run, and have to limp home. I was miserable – and taking high doses of NSAIDs didn’t help and rubbing DMSO only made me stink! (Runners out there know the DMSO smell.) Many suffer with this injury for months. It’s like a knife digging into the side of your leg or knee. The ITB is an extension of a short muscle on the side of your hip called the tensor fascia lata (TFL) as well as your gluteus maximus muscle, (that’s your behind). The ITB extends from the TFL and glut max down to the outside of your knee.
Pain occurs anywhere along the ITB, usually at the insertion (by the knee) or somewhere in the middle. You’ll have pain running, walking [usually down] stairs, and anytime you try to bend your leg, especially after keeping it straight for a while. Waking up in the morning will be like an ice-pick in your leg. If you’ve ever had ITB(F) syndrome, you probably went through a whole slew of treatments and still had it for 3-6 months; that is very common and no fun. Medical treatment is cortisone shots and NSAIDs for inflammation and if that doesn’t help, then surgery is recommended to cut and release the band. > That sounds like fishing, but much more miserable because someone would actually be cutting into a thick sheath of tendon, leaving the leg much less stable than what it was before going under the knife. ITB syndrome occurs typically from the following reasons.
Often there is an actual weakness of the TFL or glut max itself. 75% of the ITB is made up of the glut max – the major leg extensor powerhouse muscle you use to jump, climb, squat, run, ride your bike, and even just to get out of a chair. This weakness could be from a structural imbalance, an injury somewhere (anywhere in the body), an insulin issue from eating too many carbohydrates creating a gait disturbance, or even from a digestive problem, (gut inflammation can inflame the ITB). One or both of those muscles could have fatigued from wearing the wrong type of shoes or orthotics, or even from an old injury that is still haunting you, but you don’t know it because the pain is gone, but your body has compensated.
Second, ITB Syndrome can also occur from an imbalance between the inside and the outside of the leg. The muscles that support the inside of the knee are related to the adrenal glands. These are the sartorius, gracilis, as well as one of your hamstring muscles on the inside of the back of the leg that wraps around to the inner lower knee. If there is an adrenal involvement from overtraining and/or too much life stress, these muscles will weaken, causing an over-firing of the muscles on the outside of the leg/knee, which as you now know, is the ITB and TFL. Or the muscles on the inside of the leg could be working too hard so the outer leg muscles – the TFL and gluteus medius and minimus – are pulled inward, essentially torquing the leg. Treating the injury with this understanding usually corrects it very quickly, often within a couple weeks, if not sooner.
Check out the Sock Doc ITB natural treatment video!
Also read how Sock Doc treated a local East Coast runner successfully who had ITBS for months here.
Coach Terp says
This is precisely what happened to me —over-training, running hills, and increasing my distance too quickly, I suspect. Everything you mention is applicable to my case —sharp pain, especially walking down the stairs, trying to bend the knee (like a broken hinge), etc, etc.
You assert that we shouldn’t ice it or stretch it, which makes perfect sense; but this also begs the question —just what do we do?
Perhaps I would be well-served wrapping it up, getting a brace, and just taking time off until it mends itself?
I went from zero running in 15 years to running 2.5 miles my first time out three weeks ago to running 11+ and ‘running through the knee pain.’ Lessons learned the hard way.
Sock Doc says
“What do we do”? – Start by what I discuss in the post and video!
I have a fun combination of ITBS and piriformis pain at the moment, as well as some residual hamstring pain. Felt a slight twinge in the back of the hamstring about a week ago, and then I stupidly went ahead with a long run a few days later (training for the Leadville 100, so it was about 30 miles), where it really flared up. It’s now being stubborn about going away. I had similar pain after my last 100, but have been injury free in the last five or six months, despite some pretty high mileage (80-110 miles a week).
Right now, I’m a little less than three weeks away from race day, and I’m nervous I won’t be able to shake it.
I definitely have deep knots in the butt and the hips on both sides, which I’m trying to work out with a trigger point massage ball, foam roller, and self massage. I also discovered, after watching your video, that I have pretty serious tension on the inside of the knee. I’ve started working on those knots, too.
A few questions:
1) You say you should work the trigger points for 30-60 seconds at a time. How often? Once a day? Twice a day? Three times?
2) I’ve taken to cross training to avoid irritating the IT band itself. One of the things I do is to walk uphill on a treadmill at maximum grade for about 45 minutes. I think this probably puts some pressure on the glut max, but it doesn’t seem to bother the IT band itself, which is why I do it. Do you see any issue with this, assuming I don’t experience pain during the workout?
3) You mention that it might be ok to heat the IT band itself. Is there any sort of guidance to know when in the process it’s ok to try heat? I’m not in pain in any consistent way; I’m just trying to the underlying IT band irritation so I can run in three weeks.
As background, I’m very familiar with your site, and I’ve been very strict about my diet lately. Lots of nuts, berries, broccoli, fish and fish oil and other anti-inflammatory foods.
Any suggestions you could provide would be greatly appreciated.
Thanks so much for your help — I’m a huge fan of your site.
Sock Doc says
Three weeks kinda tough would but hopefully some of this will help. – (Would love to get my hands on you and get that ITB fixed up!)
1) More on trigger points here: https://sock-doc.com/2012/04/trigger-point-therapy/
2) That should be fine if your pain isn’t made worse.
3) Try the heat if it makes it feel better – typically you’ll know soon enough (after using it 1-2 times). More on that here: https://sock-doc.com/2012/07/first-aid-for-injuries-part2-ice-heat-rice/
Thank you for this beautiful article and video! I have ITBS for 3 months… Last week I tried to run but the pain persists. For 3-4 days I felt a sensation of swelling on the knee and around the patella. Ice or stretching have no effect! Is it normal this sensation? And can I do something? Thanks a lot!
p.s. Sorry for my bad English 😛
p.s.s. I’m a medical student and a runner(for passion) and I love this “open mind” approach in this field. I hope that this mentality spreads very soon in the modern medicine!
Sock Doc says
No pain like that is normal. See how the information I show in the video helps you out as well as the Knee Video: https://sock-doc.com/2012/04/sock-doc-knee-video/
Also note here at Sock-Doc we don’t stretch, and we don’t use ice >> https://sock-doc.com/sock-doc-first-aid-for-injuries/
Hey Sock Doc,
How do you feel about contrast hydrotherapy for ITBS?
Sock Doc says
I’d say it’s a waste of time and going to delay your healing. Check out Part II here: https://sock-doc.com/sock-doc-first-aid-for-injuries/
Doc., I need your help 🙁
I’ve already tried pressure point option for my ITB pain. Every time I run, by mile three, I’m already feeling pain on the outside of my right knee. My left rotator cuff is fine now (had an injury there back in September (I heard in your video about gait being a possible reason for ITBS)). Yesterday I couldn’t even get up from my couch (6 hours after running 13 miles).
I did not run at all this past week to “save” myself for my Sunday long run. On 12/8/12 I ran 11 miles (same story; same pain).
I don’t know what to do anymore. I’m not using orthotics, not stretching the pain, no ice and I do run in minimus shoes. I’m trying to follow a training program for a marathon (1st timer) and it increases mileage throughout 18 weeks, but I find myself injured all the time.
You already helped me with an Achilles problem (I stopped running for almost a month), and now this. I’m freaking out. Marathon is on 2/24/12 and I’m barely on mile 13 (supposed to run 20 max during training) :'(
Sock Doc says
Well that stinks but you’ve gone from one injury (AT) to another (ITBS). Clearly you’re not doing something right (or something is not right) – either old injuries are haunting you, your gait is a problem from footwear or those past/current injuries, diet, life, training improper. Really can’t suggest anything more specific. You can always come see me or consider a phone/Skype consult.
I have a very frustrating ITBS case. I’ve been running for less than a year, 8 months maybe, the pain stared after my first 10k and never went away. I stopped all running activities for a couple month, and then started training again, running 15 min the first week, 20 the second, 25 the third, 30 the fourth week (all good so far), 30 again the fifth week and BUM, pain came back…. and here I’m… today I tried running and I had to stop at the second minute!! The pain is not to strong, probably because I always stop as soon as I fell a little something, but it’s there. I wearing proper shoes, I’ve always eat good (fruits, vegies, meats, fish, no carbs at night), I’m only 25 years old… I went to a doctor who made me a very thourought physical exam and only found that a have and hight foot arch (supinator???)… Excuse my english, I’m from Caracas, Venezuela…. I hope you can give me some good advise, I love running and don’t wish to quit 🙁 Thakn you!!!!!
Sock Doc says
Best advice I can give you is to watch the ITB Video and read the Sock Doc First Aid Series.
Your arch height has nothing to do with this.
I’ve been ramping up my running for some summer races, and I went out for a run a week ago, but ended up half an hour away from home with major pain on the outside of my left knee. The next morning I could barely walk at work, and after a little research quickly realized it was ITBS. I watched your video, and poked around looking for sore spots. I didn’t find a whole lot, put poked around anyway without seeing much in the way of results. After thinking about it some more, I realized that I had been upping my pace during my runs, because I felt good. Although I am really struggling to identify where my gait/form was inadequate or falling apart, my only conclusion was that I must be suffering in the stability category of running without realizing it (can’t fire a cannon from a canoe). I went through some exercises, and even though I can do things like stand on one foot with my eyes closed no problem, I couldn’t think of anything else that could have caused this problem. So for the last week I’ve just been doing mobility and stability exercises recommend by Dr Mark. As the week went on, the pain slowly subsided to essentially nothing, so today I tried to go for a very easy run, but within 100 meters I could feel the pain creeping back into the side of my knee.
I’m at a loss here 🙁 do I just need to wait longer for the ligament to heal, and keep doing stability and mobility exercises?? I don’t think it’s diet related but if it is I can’t imagine the trouble I’m going to have figuring out what the heck it is……..
Sock Doc says
Would really need to see you to figure out why it’s not healing.
Well Doc, perhaps I am quite impatient, because a day or two later, and religiously doing the strength & mobility exercises, plus soft tissue massages and I successfully ran a mile without any of the same IT pain. No agitation when walking either. Although I would like to put a few notes down here and see what you think. Some things I noticed:
1. A little bit of tightness in the knee area, most present right below the back of me knee and a bit toward the outside. Nothing to complain about, and I massaged it out, but just interesting.
2. In my research I came across this article (http://www.marchellerdc.com/pro_resources/Articles/DC_66_local_Stabilizers.pdf) and noted the section on the local multifidi. I did the exercise in the article to locate the muscle, and then did the exercise to activate it. I’m wondering if this had any effect on my knee. What do you think about the local multifidi? Is there a reason you don’t mention it in your video on ITBS?
Thanks for your thoughts!
Sock Doc says
I can’t comment on every muscle – sometimes I end up fixing an ITB issue by dealing with a shoulder problem. Anything can cause anything. So although the multifidi can be an issue, in my experience I’ve never see it to be.
I believe i have ibs. It hurts so bad. I am not a.athelete.at.all. i had decompression surgery a year ago. This started with planter faciatis. I am a.week barefoot. Somewhat better..will this help as like i said im not active and overweight.
Sock Doc says
I assume you mean ITBS and not Irritable Bowel Syndrome? 🙂
And yes I think the information I present will help many.