The iliotibial (IT) band is an important but also problematic piece of connective tissue in the body. IT band syndrome is a common cause of knee pain and the most common source outer knee pain in distance runners and cyclists. (1)
The pain can be enough to stop you in your tracks, derailing training or even just regular activity. Fortunately, exercises that involve both stretching the IT band and strengthening key muscles, can prevent and treat this condition.
Your iliotibial, or IT, band is a long, thick band of connective tissue called fascia. Fascia is the tissue that extends throughout the body to connect, stabilize, enclose, and separate muscles, organs, and other tissues.
The IT band runs from the outside of the hip to the outside of the knee. It serves several purposes, including stabilization of the hips and knees. It also provides elastic tension that helps the hip and knee flex and extend.
IT band syndrome occurs when the band rubs against the outside of the knee causing irritation, inflammation, and of course, pain. Less commonly it does the same higher up, causing pain at the hip joint.
Knee pain is very common and has many causes. Use this exercise guide to help your clients move better with less knee pain.
There are two primary ways this injury develops, both often associated with certain sports and activities:
Tightness in the IT band causes it to shorten, thicken, and rub up against the knee or hip joints.
Repetitive flexing and extending of the knee lead to rubbing and inflammation against the joint.
In athletes, IT band injuries are most common in those who repetitively move this way. Examples include distance runners and cyclists. Ramping up training programs too quickly, ignoring strength training, and overtraining all increase the risk of developing IT band syndrome. Old or unsupportive running shoes can also impact IT band issues.
Anyone, however, can develop this condition. It has been associated with sitting for long periods and even wearing high heels.
Distance runners have the highest rates of IT band syndrome. Check out this guide for runners to prevent IT pain and injury.
Exercises can help in two ways. IT band stretches lengthen and loosen the IT band prevent or lessen friction against the knee joint. Strengthening exercises target key muscles that stabilize joint movements and correct improper form can also help. Researchers found that exercises strengthening the gluteus medius and hip abductors are especially beneficial. (2)
Stretching is a great preventative measure and ongoing treatment for IT pain relief. Anything that loosens a tight IT band will reduce friction and irritation.
A standing stretch is a gentle way to begin loosening the IT band without overdoing it. Stand upright with your feet together. Cross your left foot over the right. Set it down parallel to and on the outside of your right foot. Reach down toward your toes to feel the stretch.
This stretch allows you to push it a little more. You’ll need a stretching strap or a towel to do it. Lie on your back and extend one leg up, keeping it straight at the knee. Loop the strap around your foot and pull your leg across your body until you feel a stretch.
To target the IT band right at the knee where it is causing the most pain, try this stretch:
Lie on your side with the leg you want to stretch on top.
Bend the top leg at the knee and grab your foot to pull it back behind you. You’ll feel a stretch in the quads.
Lighten up on the stretch a little bit until you can lift your other foot and rest it on the outside of the top knee.
Slowly and gently push this foot toward the floor to feel the stretch in the top knee.
For the best stretch in this position, keep the rest of your body neutral and still and really focus on the outside of the affected knee.
Use a foam roller to stretch out the IT band in addition to these other exercises. Position the roller along the outside of the affected leg and use gentle pressure and slow movement to roll up and down the IT band.
Stretching might not be enough to relieve IT pain. Tightness often contributes to but is not necessarily the main cause of IT band injuries. Poor running form and muscle imbalances or weaknesses are often the primary underlying issues. Strengthen key muscles to improve how you move and to reduce or prevent IT knee pain.
This is an easy exercise for beginners that strengthens important stabilizing muscles around the hips. To do it, stand with your right foot on a step. The foot should be parallel to the step and at the edge so that the left foot hangs off the step.
Keep the body facing forward and your legs straight as you lift the left hip and then release it back down. Repeat this several times and on the opposite side.
This is a great exercise for IT pain, especially for runners. It targets a hard-to-reach muscle essential for hip stability when running: the gluteus medius on the outside of the glutes.
To do a clamshell lie on your side with one leg stacked on top of the other and with the knees bent at a 90-degree angle. Keeping the feet together, lift the top knee and squeeze.
The movement is small and precise, so don’t overdo it. Lift and squeeze until you feel the side of your top glutes contract.
This exercise hits a fuller complement of hip abductor muscles, including the gluteus medius, gluteus medius, and others associated with the rotating and stabilizing of the hip.
Place a resistance band around your legs at the ankles. You can start with a looser band and progress to more tension as the muscles get stronger.
With the band in place step to the side as you feel the tension in the band increase. You should feel this in the muscles on the outside of the hip. Take several slow steps to one side and then repeat on the other side.
Strengthening the larger gluteus maximus muscles is also crucial for good running and walking form. When you have mastered the lateral band walk, make it more difficult by doing it in a squat.
Start slowly and deepen the squat as you progress. Keep your chest and back upright and avoid hyperextending your knees over your toes.
A weak core contributes to poor form in many types of movement, especially running. Anything you can do to strengthen core muscles will support IT band health.
Side planks are particularly useful because they strengthen the abdominal and hip abductor muscles. Rest your weight on your bottom forearm and foot. Keep your spine straight and avoid sinking down into the bottom neck and shoulder. Rest the top foot on top of the bottom one and hold this position for about ten seconds. Repeat several times.
A standard forward plank is also useful for strengthening the core. Try variations to progress, such as shoulder taps, alternating leg lifts, and mountain climbers, reaching your knees toward the hips one at a time.
This exercise helps activate the gluteus maximus and glutes medius muscles. If the glutes are weak or not firing properly, the tensor fascia latae (TFL) can be overused, which impacts the IT band. Strong, balanced glutes can help prevent IT band syndrome.
Begin lying on the floor. Position a resistance band around your legs, slightly above the knees. Bend the knees with the bottoms of your feet on the floor hip-width apart. Keep the upper back pressed into the ground, and raise your hips while pressing the knees outward to keep tension on the band. Squeeze the glutes at the top, pause for a few seconds, then slowly lower the hips back down to the ground.
Keep in mind that many people develop IT band pain due to overtraining. While exercises help, it is important to take time to rest. If you have significant pain, stop training or change your activities, ice the painful area, and take a break.
If you continue to have IT issues even with stretching and strength exercises, a physical therapist can help. They can identify specific issues and tailor a program of exercises to your needs.
Injuries are, unfortunately, a common part of fitness. The ISSA Certified Personal Trainer – Self-Guided Study Program prepares you to help clients prevent and manage injuries like sore IT bands so they can meet their goals.
U.S. National Library of Medicine. (2022, May 30). Home - books - NCBI. National Center for Biotechnology Information. Retrieved November 8, 2022, from https://www.ncbi.nlm.nih.gov/books
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