IT Band Syndrome: The Sticky Truth

Clinical Author - Jessica Snyder, DPT

Clinical Author - Jessica Snyder, DPT


It’s an all too familiar twinge. You are out on a mellow run, feeling awesome - and then it hits...

Pain on the lateral side of your knee that stops you in your tracks. The culprit? Iliotibial Band Syndrome.

Your heart sinks. But you shake it off and decide to do what any good runner would do: throw back some IBU, take a week off and then go for a test run. Surely that should do the trick, right?

A half mile into your run, the IT Band is fired back up and has returned with avengeance. But why?

First, nothing has changed. Injuries have a cause and effect relationship. What caused the IT Band to become irritated in the first place? This likely hasn’t been addressed in your week off from running or cycling. The same outdated injury prevention advice isn't always going to cure an IT band injury. Instead, proactive and intense injury treatment is needed to get healthy and cure your ITBS for good.


So What CAN You Do?


Functional Strength Training:


A large percentage of IT Band issues stem from weakness in the glutes and lumbo-pelvic-hip complex. It is critical to strengthen these areas (as well as your intrinsic core muscles), if you want to be IT Band Syndrome free. At Physical Therapy Elite, we conduct comprehensive evaluations and gait analysis to identify the source(s) of tissue restriction, faulty movement patterns and muscular imbalances in order to provide individually tailored and specific strength programs. Addressing the “cause” will cure the “effect”.


Tissue Work and Mobility:


First, let’s shed a little light on the IT Band. The Iliotibial tract (the IT Band or ITB) is composed of extremely dense connective tissue - fascia. Imagine several layers of pact tape. Pulling on those layers of pact tape is NOT going to cause them to stretch.


Next, the ITB starts at the Tensor Fascia Lata (hip flexor muscle) and runs down the outer thigh to connect to Gerdy’s Tubercle on the outside of the tibia (essentially the outside of the shin just below the knee). The TFL, being a muscle, is elastic and CAN therefore stretch.


The fascial fibers of the ITB blend with the muscle fibers of the quads and hamstrings. There is no line separating or isolating the ITB - its outer edges are woven together with the lateral quadriceps and the lateral hamstrings. This is important because tightness in these muscles, including the TFL,  will cause the ITB to stick down.


So, stretching of the quads, hamstrings and TFL will alleviate pressure on the ITB. This is important because the ITB crosses both the hip and the knee joints. If it is stuck down, it is exerting a significant amount of compressive force on the joints.

*Think about the line of pull of the’s vertical...resulting in joint compression…

Manual therapy (tissue work) is extremely effective at increasing tissue mobility, thus creating healthier tissue. It improves the SLIDE, GLIDE, BEND of the tissue. This is essential for the ITB as well as for the muscles. SLIDE, GLIDE, BEND allows for blood flow and oxygen and reduced neural compression.


It is important to understand that tissue mobility is extremely beneficial due to its ability to create physical change in the tissue via the physical pressure being applied and the underlying neural inhibition that is occurring simultaneously. Especially considering that you are working on more than a single structure as the muscles and the fascia are so intricately connected and impact each other significantly.


Resolving IT Band Syndrome

So what have we learned? Rest alone in not going to “cure” ITB issues. Increased tissue MOBILITY in conjunction with STRENGTH are critical components to saying goodbye to IT Band Syndrome - for good.