Iliotibial Band Syndrome (ITBS)

Last kickoff post for this forum for now, but we can always add more.

Here’s another common injury—iliotibial band syndrome, which results in pain on the outside of the knee, not the front (that’s patellofemoral pain syndrome).

Although my IT bands are tight and sore when I roll on a foam roller, I’ve never had too much trouble with them, so again, I’m going to defer to the PainScience guy for a big overview. (And no, I don’t get a cut if anyone actually buys his books—he’s just a one-man publisher doing good work.) But let us know what you’ve experienced and done for treatment, and we’ll start beefing up this first post.

From 2012, the Running Writings Injury Series has a detailed post as well:

RunnersConnect also has a good article on ITBS:

This was my first major injury and something that I’ve had to keep an eye on for about 10 years now. I’ve done the stretches, and I admit that the strengthening drills have helped to keep ITBS at bay, especially at the hips. While the pain typically manifests at the knee, I have in later years found pain right where it connects near the hip. Doing the stretch where you put your foot across your other leg and hug your leg/knee helped me there in that case.

I’m really surprised about the negative reaction to rolling by PainScience, considering how many people I’ve known that it’s helped. It helped me immensely I guess that’s just anecdotal then. A quick google search suggests a lot of people saying not to do it too, though some say it’s useful to roll the muscles of the thigh anyway. I guess I could say here too that for any kind of rolling, I would also consider getting a PVC pipe. It’s way cheaper, won’t degrade over time, and allows you to dig deep when rolling. It’s definitely uncomfortable if you’re not used to it but you can always hold yourself up a bit to avoid the full force.

EDIT: Oh, I will also say that in a pinch, I have used one of those bands that goes over the knee. It’s really a temporary aid, so it’s probably not too useful since it’ll cost money for only a stopgap measure. But, if that’s what you need, you might consider it.

With regard to rolling, I haven’t read that particular section, but it’s always possible that it has some sort of effect that’s helpful even while not doing what it’s “supposed” to do.

And about the knee bands, Paul Ingraham has a short article about them, and while he’s generally down on gadgets that promise to help with no real science behind them, he suggests that a strap could help from the standpoint of changing proprioception of the knee or by essentially distracting the brain from chronic pain that isn’t reflective of the tissue state of the knee. Again, it might fall into the category of something that’s helpful, but not at all for the reasons intended.

In regards to the rolling/myofascial release/any other term to describe mechanical pressure on tissue:

The actual etiology of ITBS is proposed (it actually isn’t entirely known) to be compression of the fat pad on the lateral side of the knee underneath the IT band. This is fairly similar to a lot of tendinopathies we see, where compression of the tendon at its insertion seems to be the aggravating factor. Clinically, I treat ITBS as a tendinopathy- while stretching/rolling can give some folks short-term pain reduction (and others no results), it isn’t going to change the amount of compression on the fat pad or, most importantly, the fat pad’s tolerance to loading. For a bit about load tolerance, see this general blog post I wrote about the “envelope of function” in running injuries:

What does effect load tolerance is… progressive loading. This could be running, cycling, resistance training, etc. Basically anything that conditions the area to tolerate more reps/loading cycles/force over a gradual period of time and essentially working around pain/irritability. It then sounds fairly reductionist in that we almost don’t need to consider the actual source of the pain from a tissue standpoint, but one of the reasons it’s still helpful to know that sometimes is it can guide what type of load we can or can’t tolerate (ie loading a tendon at the same weight in a midrange vs compressed position).

Hope some of this helps!

1 Like