How to Treat Iliotibial Band Pain

The Iliotibial Band

Certain types of pain or injury tend to pop up when training frequency and/or intensity increases. This is unfortunate because just when you’re hoping to take it up a level ahead of a race or event that you’ve been training for – bam! you run into a setback. One of the more common examples of this is the dreaded Iliotibial Band Syndrome, or ITBS.

The symptoms are usually pain anywhere down the lateral (outside) of the leg and possibly sharp pain into the outside knee. It can even be a sacroiliac pain which presents as low back pain some of you get after a long run. ITB pain can become so uncomfortable that it may cause you to have to take a break in training for a bit, so let’s take a look at what’s going on.

The Iliotibial BandThe ITB is a long fibrotic band of fascia that extends from the gluteus maximum (you know, the one you sit on all day) and the tensor fascia lata (TFL), a short muscle located at the very top of the hip bone, and runs down the leg and inserts into the ITB around the boney prominence of the hip (the greater trochanter). In short, it is a leg flexor and stabilizer that runs down the outside of your thigh.

ITB pain typically occurs after a change in miles, pace or terrain. The dysfunction can be due to any of the following:

  • Weakness in either the gluteus maximus or TFL
  • Structural imbalance
  • Inflammatory response
  • Poor equipment (like old shoes)
  • General overuse injury

The actual pain is usually from the tight band rubbing over the quad muscle and the rotation of the hip due to the TFL shortening (contracting)and causing tension or pulling on the ITB.

Now, here is where things get a bit tricky. The ITB actually needs to be tight because we need it to stabilize the outside of the knee. Therefore, the release we normally do in muscle isn’t necessarily appropriate here.

What’s the first line of treatment you can do to ease the pain and get running/cycling again?

Go back to those two main muscles that are activating the ITB: the TFL and the gluteus maximus.  This is where you need to release any contracture, trigger point and adhesions.

The first approach I recommend would be to use a tennis ball or other release tool to get into the gluteus maximus and search for a sharp pain area. Hold for a few seconds (60-90) with the tennis ball and then roll that same area gently with a foam roller. Same for the TFL. Be sure to go slowly and easy here; it’s a sensitive area!

For now, avoid foam rolling the length of the ITB. This is better treated with moist heat and easy stretching.

If your ITB pain is being stubborn and just won’t go away, reach out to me for more in depth treatment to get you running again!

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