ITB (Iliotibial Band)


Experience From - Bryan Erickson , Pete Petri , Jeff Selinger , Pete Petri#2 , David Elsbernd #1, Jon Engelstad, Dave, Kevin Kepley, Rich Schick, Jon Engelstad#2 , Bob Rayburn , Bob Rayburn#2 , Kevin Kepley#2 , Chuck Barbee , Kristen Kern , Sean Greenhil , David Elsbernd #2, Al Czecholinski , Bob Marston ,

Bryan Erickson

I too have been plagued by the IT Band, but recently I found a mix of shoe and orthotic along with correct stretching to fix the problem. I first got it about a year and a half ago and couldn't run much less walk faster than a stroll for about 3 months. I got over that, only to get it on the other leg while in Airborne School causing me to drop out. Both times were from improper stretching along with running in combat boots (sometimes unavoidable in my line of work).

The IT Band actually is the band of tendons that run from your hip area all the way down and connect right below your knee. IT Band Syndrome is the IT Band actually rubbing against the bony part of your knee as it bends.

I have to stretch at least twice as long as I would normally think to stretch. I also pronate, so I have to wear motion control shoes, and ever since I felt some tenderness there during the Seattle Marathon, I've worn some small Dr. Sholl's arch supports. Seems to work for me.

Other than stretching, correct shoes, and icing after the injury happens (if it comes up again), it's kind of a hard injury to get completely over.

Pete Petri

I read on article on Runners World online several months ago about a Stanford study which found a common problem in runners suffering from recurring ITBS was a weak muscle in the hip area that helps to keep the leg moving in correct alignment (it read better at the time than I am paraphrasing ;-)). To combat this, they suggested 2 exercises, one of which I didn't get how to do correctly from thier description. The one I did understand goes like this:

Lay on your good side, with your back against a wall. Make sure your shoulders, buttocks and heels touch the wall. Lift the afflicted leg straight up in a scissors motion, keeping your heel against the wall.

I started off with 2 sets of 10, as it really was hard in my hip. Now I do 3 sets of 10 every morning, and my leg has felt great.

Of course, I also do daily stretching, along with post running stretching. I take my ITB seriously!

Jeffrey Selinger

Jeff wrote:

"(I have no medical training.) I suffered from IT band friction last year. Not running seemed the only option. Attempts to run ended in excruciating pain after less than 1 mi. I found the condition to be aggravated by sitting at the desk all day. I strongly recommend getting up and walking around at least once an hour (even if it is painful). Putting the foot on a chair while standing and doing sort of a running stretch also seemed to help. "
I changed shoes when this problem occurred. I am not sure if that or time alone was the ultimate cure. Good news is that this problem does not bother me anymore, even with higher mileage. So don’t despair!

I did not have massage therapy. Intuitively it doesn’t seem this would improve a tendon friction problem. (Again, I have no medical training, and it may be precisely the point that somehow massage mobilizes fluid in tissues ?) Maybe someone on the list will comment on the benefits of massage. But then, isn’t massage a good treatment for anything ?

I noticed that you mentioned an aggressive bike ride prior to the flare up. I know a sitting position aggravates the ITB friction problem. Putting two and two together, I am wondering if it might have been the bike ride that caused your flare up. I am thinking about doing more biking cross training this year to lower the work load on my feet, but now that you remind me of ITB, I am having second thoughts. That is why I asked the question at the top of the message.

One final note. I found that I could ‘feel’ the friction when this was a problem. Running when I could feel the friction quickly caused the pain to flare to immobility. Trying to run really seems to be counterproductive when you are in this condition.

Pete Petri #2

Jeff wrote:

"I did not have massage therapy. Intuitively it doesnít seem this would improve a tendon friction problem. (Again, I have no medical training, and it may be precisely the point that somehow massage mobilizes fluid in tissues ?) Maybe someone on the list will comment on the benefits of massage. But then, isnít massage a good treatment for anything ? "
The explanation to me was this:

This is not a "massage", where the muscles are rubbed along the grain, and you end up feeling all loose and limber when you get off the table. Cross friction can be quite painful, but for a reason. Tendon damage causes tissue scarring, and the scars can become hard and inflexable. The purpose of cross friction is to break down the scar tissue and return the tendon to some semblence (sp?) of its original self.

When I was having cross friction done to my ITB last year, the PT would press down on the painful part, and rub it back and forth. He stated that he was rubbing it against the bone to break down the scar tissue. This, followed by ultrasound with an anti-inflammatory gel and then icing, turned the trick for me.

Note: I am not a doctor and don't claim to be one...this is just what we would talk about to get my mind off how he was torturing my knee ;-)

David Elsbernd #1

Jeff wrote:

"Does biking particularly aggravate the ITB friction problem?"
Biking allowed me to get in shape in the first place, until I could solve my ITBS problem. Biking only incidentally irritated my knees, compared to running. I suggest making sure the seat is at the proper height, feet are aligned straight, and the knees go up and down in one plane and don't wobble from side to side. There could be other factors such as cadence. I also used toe straps. You'll have to try biking and see for yourself, I guess. ITBS stretches, orthotics, good shoes, and changing my stride mechanics finally did the trick for me.

Jon Engelstad

A few weeks ago, I posted an email concerning some sort of knee pain that I was having. I have since gone to a good orthopedic surgeon that diagnosed the pain as ITB tendonitis. He then refered me to a physical therapist and prescribed some anti-inflammatory pills.

I know a number of people on the list have probably experienced some sort of ITB pain, and I hope that I might learn from them. The main actions that I have taken since the pain and diagnosis are:

  1. Icing the knee a few times a day for 15-20 minutes at a time
  2. Cutting back running mileage
  3. Cross-training more (biking, stairclimbing, racquetball, etc.)
  4. Take anti-inflammatory medicine
  5. Try to run on softer surfaces: trails, grass, etc.
  6. Stretch often, focusing on ITB stretches
I have only run one ultra (100K), but I plan on running several 100s in the next 6 months, and I know it is important for me to get healthy before I attempt such a distance.

Does anyone have any advice related to fixing my ITB condition?


Jon, Find a good masseuse and get the area around the ITB massaged a couple of times a week for 3 or 4 weeks. It worked wonders for me.

I'm not sure if I would xtrain on the stair climber, but pool running is a great way to stay in shape and, somewhat, duplicate the motions of running.

The only other thing is to take some serious rest days.

Kevin Kepley

David Emmons wrote:

"A friend of mine is bothered by what I diagnosed as ITB syndrome. It was described as a pain running down the outside of the knee from about 4 inches above to 4 inches below the joint. I would like to pass on any remedies or reliefs fellow listers have found that alleviate the pain. He said that he has been plagued with the problem since his high school track days. (he is now at the ripe old age of 25) We recently went on a 20 mile trail run in which he did fine, only minor discomfort. After the run however, the pain got increasingly worse. Any advice would be passed on with great appreciation."
I developed a problem with ITB induced trochanteric bursitis after my second marathon. It's never gone away, but I've learned how to run with it, without too much of a problem. Apparently, what happens is that the ITB becomes tight and it irritates the bursa at the hip (the ITB runs from above the hip to below the knee). In turn, the bursa is no longer able to properly lubricate the joint and running becomes painful. I started doing the ITB stretches, and this helped some. Then someone told me about glucosamine sulfate. When I started taking this, I went from being barely able to run, to ramping up to run a marathon in about two months after hardly running for weeks.

Someone recently posted about an ITB site:

Rich Schick

Below is a couple abstracts on the subject for your enjoyment. as appropriate - Am J Sports Med, 24(3):375-9 1996 May-Jun
We propose a biomechanical model to explain the pathogenesis of iliotibial band friction syndrome in distance runners. The model is based on a kinematic study of nine runners with iliotibial band friction syndrome' a cadaveric study of 11 normal knees' and a literature review. Friction (or impingement) occurs near footstrike' predominantly in the foot contact phase' between the posterior edge of the iliotibial band and the underlying lateral femoral epicondyle. The study subJects had an average knee flexion angle of 21.4 degrees +/- 4.3 degrees at footstrike' with friction occurring at' or slightly below' the 30 degrees of flexion traditionally described in the literature. In the cadavers we examined' there was substantial variation in the width of the iliotibial bands. This variation may affect individual predisposition to iliotibial band friction syndrome. Downhill running predisposes the runner to iliotibial band friction syndrome because the knee flexion angle at footstrike is reduced. Sprinting and faster running on level ground are less likely to cause or aggravate iliotibial band friction syndrome because' at footstrike' the knee is flexed beyond the angles at which friction occurs.

Am J Sports Med, 17(5):651-4 1989 Sep-Oct
A selected group of 23 patients underwent surgery for iliotibial band friction syndrome. Among the patients presenting with this exertional pain syndrome were runners, football players, and cyclists. Diagnosis was clinical since radiographs were negative and an ultrasound examination was positive in only one case, showing an aberrant picture around the lateral femoral epicondyle. Although conservative treatment is effective in most cases, an alternative is needed for patients with complaints that are resistant to conservative means.

Surgery was done with the knee held in 60 degrees of flexion and consisted of a limited resection of a small triangular piece at the posterior part of the iliotibial band covering the lateral femoral epicondyle. The uniform good results, low morbidity, and quick return to sports demonstrate that this type of surgery offers a solution for selected cases of failed prolonged conservative treatment.

Sports Med, 14(2):144-8 1992 Aug
The iliotibial band syndrome is most often diagnosed in runners but can be found in athletes who participate in other sports. From our experience most patients are high mileage runners with shoes either worn out or with insufficient cushioning. A total of 19 athletes with this condition have been seen in the past 3 years. Treatment consisted of rest or decreased distance' shoe changes' modification in exercise technique' anti-inflammatory medication' steroid inJections and stretching. Surgery was not required.

S Afr Med J, 79(10):602-6 1991 May 18
Forty-three athletes presenting with unilateral iliotibial band friction syndrome (ITBFS) were randomly divided into three groups for the first 7 days of treatment (placebo-controlled' double-blind): 1--placebo (N = 13); 2 anti-inflammatory medication (N = 14) (Voltaren; Geigy); and 3--analgesic/anti-inflammatory combined medication (N = 16) (Myprodol; Rio Ethicals). All subJects rested from day 0 to day 7 and all groups received the same physiotherapy outpatient treatment programme from day 3 to day 7. On days 0' 3 and 7 the subJects performed a functional treadmill running test (maximum 30 minutes) during which they reported pain (scale 0-10; 0 = no pain' 10 = unbearable pain) each minute. Total running distance' total running time and the area under the pain v. time curve was calculated. Daily 24-hour recall pain scores were also recorded. The 24-hour recall pain scores decreased significantly for all the groups over the treatment period. This method of assessing efficacy of treatment therefore failed to show differences between groups. In contrast' during the running test only group 3 improved their total running time and distance from day 0 to day 7' whereas in all the groups the area under the pain v. time curve decreased from day 0 to day 7. All the other groups improved total running time and running distance from day 3 to day 7. All three treatment modalities are effective in the early treatment of ITBFS but physiotherapy in combination with analgesic/anti-inflammatory medication is superior.(ABSTRACT TRUNCATED AT 250 WORDS)

Jon Engelstad #2

I've got a question about crosstraining and ultrarunning that is similar to one recently posted. I am becoming convinced that crosstraining is the key to staying healthy while running. I have been trying to run through some ITB inflammation/pain recently, until I realized that it was not going to work, and that I was only making the problem grow. I have been going to an orthopedic doctor and physical therapist (massage and ionopheresis - transdermal delivery of anti-inflammatory medicine)for a few weeks now, and I just got a cortisone shot this past Friday.

The doc says I should take at least a week off, and then over about eight weeks build up my mileage to running alternating days of 40 and 20 min. The program begins with fast walking for the first week or so, and I am not even allowed to run for a few weeks. Being injured, and being forced from being a competitor to a spectator is extremely frustrating!

My question is: what kind of activities could I safely do so that when my ITB is better, I will be in good shape to run. My target is Leadville in four months. I understand that the ITB rubs whenever the leg is bent over about 25-30 degrees from straight. This obviously rules out a lot of activities that use the lower body!

The activities that I typically do are: swimming, stairclimbing, running, walking, cycling, racquetball, rollerblading. How about doing some good leg workouts with weights? Which of these are good substitutes for running while not being too hard on my ITB? As always, thanks in advance for all of the help! I hope to see a lot of you at Leadville with my new and improved ITB.

Bob Rayburn

Jon, Be careful about the "one week off". Last year I developed ITB problems and probably exaccerbated it by continuing to run for two or three weeks. I took five weeks off in total: each week Iwould try a mile or two and stop if the pain began. After the five weeks it was fine and never came back. I never stretched my ITB prior to this but now it is a regular post run stretch. I know this does not help with your cross training question, but if you take a little more time you probably will be able to say goodby to ITB problems for good.

Bob Rayburn #2

I would agree partly with Matt and partly with David. If it really is ITB, forget about reducing milage, stop altogether (horror of horrors, but it is true). Ice your knee during the day when you can, but also message the IT band with your hand when you are seated (at a desk or any other sedentary activity), moving your hand from the mid thigh to the knee, applying some pressure. And finally stretch it: there are several good stretches, either seated on the floor or standing. Try to stretch it 2 or 3 time a day, holding the stretch for at least 30 seconds, preferably 60. What essentially you are trying to do is to return the elasticity too this band which has become somewhat rigid.

Start out with short attempts at runs after four weeks: if the knee gives any pain, stop, walk home and try again in 3 or 4 days time. Seems like a long process but it does work. When you are back to running, keep the ITB stretches as a part of your regular post run stretching.

Kevin Kepley #2

Jonathan wrote:

"I have been battling an ITBS condition for the past 8 months, and the orthopedic doctor that I have been going to says that the next step in the treatment is surgery, since nothing before has been very effective. I don't really like the idea of going under the knife, and only want to consider it as a last resort, but I desparately want to be able to run painfree again. Has anyone else had any sort of ITB surgery, and if so, what was the outcome? How long was the rehab? Did the injury reappear? "
I've had ITB induced trochanteric bursitis (hip), and have had great luck with stretching and using glucosamine sulfate and chondroitin sulfate. Most people who have ITB problems have trouble at the knee, so I don't know how much these things will help someone with that problem. Before surgery, I'd at least read Noake's comments on it in "Lore of Running", check out what's on the web (don't remember any URL's ), and make sure I'd addressed any biomechanical problems that might aggravate the problem. Since surgery is irreversible, I'd make sure I'd tried ALL other options first, then get at least a second opinion.

Chuck Barbee

I've researched the archives on ITB injuries and there is plenty of info on treatment, but I didn't locate anything on what that type of injury feels like. What kinds of pain or symptons are present with an injury of this nature? Anyone who has experienced ITB pain if you would let me know where the pain is most predominate and what particular activities aggravate it I would appreciate it.

Kristen Kern

There is a description of diagnosing ITB Friction Syndrome in Noakes that goes something like this:

Sit with your legs bent. With your fingers, put pressure on the outside of the knee over the boney protusion. If you move your knee a little, you should be able to feel the tendon moving. With the pressure, straighten your leg. At about 20-30 degrees of bend the ITB passes over a bone. If you have ITB friction syndrome you will get a sharp pain at this point.

Sean Greenhil

I've been unlucky enough to have had ITB in both knees this year.

It's a condition especially aggravated by downhill running or excessive mileage or racing. In February, I was doing a lot of my training running home from work, a 2 hour run with lots of downhill. Then I did a 45K road run with a lot of downhill and it hit in my left knee. I finished the run, but for the last 15K or so I had to run the biggest downhills backwards to relieve the pain. For more than a month afterwards, I suffered pain after running for 90-105 minutes.

I brought it on in my right knee, I suspect, by excessive racing, as I had a schedule involving six races in as many weekends. These included a 46K ultra, PBs at 8 and 10K, and a trail race with 13K uninterrupted downhill. My midweek runs were all with a workmate considerably faster than me.

Essentially, it feels like a very sharp, but quite localised, pain directly over the outside of the bottom of the femur where it meets the knee joint, although in some bad cases (like my left knee) there may be some pain further up the thigh as well. It manifests after a certain distance or time (which is usually quite consistent), then comes on rapidly. The knee often goes quite stiff as well.

David Elsbernd #2

For IT Band pain try:

  1. IT Band related stretches

  2. Stride adjustments - more push-off, less 'clumping'

  3. Assuming the problem is pronation related, motion control shoes

  4. Orthotics, if the motion control shoes aren't sufficient and if your podiatrist feels they are necessary.

Stretching is the most important item for me. Getting a good stretch is not easy, but well worth learning. I sit down and put the left ankle on the opposite knee, and press the left knee down so the leg is in a horizontal plane. I then bend forward while maintaining downward pressure on the left knee with my hand. Stretch for at least 30 - 60 seconds, and repeat for the other side. Be very diligent about the stretching. If your IT Band is tight it might take months to stretch it out satisfactorily.

The stride adjustments have given me an added bonus in that I believe my stride is now more efficient.

The pronation problem can be detected by a podiatrist. Fixing a pronation problem is important in preventing biomechanical problems. However, in my case, it wasn't a magic bullet, since the IT Band was still very tight. All the pieces of the puzzle must be addressed.

Al Czecholinski

After having several painful bouts with IT problems, a physical therapist gave me several stretches to do. By far the most useful one for me lies somewhere between stretching and message. It goes like this:

Initially I did this twice a day but now only once. For me it seemed to be most beneficial after a workout. If you have very tight tendons/ muscles like I initially did you may need to pad the rolling pin with foam as it may feel somewhat painful like a deep message. As my tendons/muscles stretched over time (I've been doing it for several years), the feeling has changed to that of a pleasant relaxing message. Try it, you'll like it!

Bob Marston

I can only provide what has worked for me and my wife and a couple of layman's ideas about what causes it.

I encountered it at the 31 mile point of my first 50 miler, about five or six years ago. The other runners knew what it was, told me to choke back some aspirin, quit whining and finish the damn run. I did everything but the quit whining part. After a reasonable post race recovery period I, like you, tried all the well-documented book remedies. That great twisting stretch, ice, ibuprofen, tylenol, running on the other side of the road, etc. Nothing worked. I was, like you, still trying to run and continually trying new ways to abate the condition. Finally, while on a Christmas vacation, still trying to get a run in, I tried what I call "toeing off". Your normal foot motion, while running gives you a natural amount of "push off" with your toes. What I did was assess the amount of push off my natural stride was giving me and then added about 10-20 % more. On this particular day I had my usual amount of IT ache at the beginning of the run. Within 5 minutes after initiating the conscious toe off, the IT discomfort abated substantially. Using this technique my IT problems, that had lasted for three weeks, totally went away in two days. Of course, I had to continue to toe off for a bit longer but I was able to run pain free. My wife has used the same technique many times, exaggerating the toe push off, and it has always worked for her within 1-2 miles of onset. I have had a couple of IT twinges since then, while running, and have always initiated the toe off immediately and had the discomfort end very quickly.

Now for two quick observations. I attribute the IT that my wife and I have experienced to be directly related to the gait that an ultra runner naturally slows to in an ultra run. If you can think about your longer runs, and I should add if you're a relative slug like me (some of my better acquaintances would say full-fledged slug), when you got tired you did a lot more running from the hips and upper leg than you did earlier in the run from the calf and lower leg. Folks like me do less push off and more leg swing in the latter stages of a long run simply because our lower legs are pretty wrecked. I honestly think that is what causes the IT aggravation.

The second observation is that IT is generally experienced in the first year or two of ultra running. I have not heard of any long time ultra runners whining about the condition. That leads to my second observation: I think after about a year or two of doing long runs and races the IT will not manifest itself except in very aggravating circumstances; for example, if you do a lot of slow running in a hundred miler. Even then, it doesn't present itself until I start on my recovery runs and is easily managed via the technique.

This is a layman's solution that has worked for both my wife and me. I certainly hope it will work for you.