It starts with a nagging pain on the outside of your knee that gets worse, rather than better, during a run. It feels like something is “popping” across the bones and, over time, the pain increases until you can no longer run.

Illiotibial band syndrome (IT Band Syndrome) is one of the most common running injuries today–and also one of the least understood. The average runner doesn’t have a clue how to treat IT band syndrome. Common do-it-yourself treatments aim include icing, stretching, foam rolling and rest.

knee pain
photo: Shutterstock

But ask most runners who have tried these treatments and they’ll say that as soon as they started running again, their IT band syndrome flared back up. It’s a stubborn injury and doesn’t respond to the treatments discussed above. IT band syndrome is not an injury of inflammation (so icing won’t help) or tight musculature (so foam rolling the band itself or stretching won’t help).

So, what does work? Let’s discuss the structure of the injury first to understand the true nature of IT band syndrome.

What Causes IT Band Syndrome?

The Illiotibial band is a thick piece of connective tissue that runs parallel to the femur from the hip to the knee. It attaches along the gluteus maximus and tensor fasciae latae on the side of the hip and connects on the lateral side of the tibia. One of its major functions is to stabilize the knee while running.

ITB Anatomy
photo: Shutterstock

IT band syndrome is diagnosed when pain presents at the insertion point of the IT band on the outside of the knee, typically caused by compression due to an abnormal movement pattern of the femur.

So what causes your femur to move abnormally? Usually, a weak butt. Your gluteus maximus and medius are the two major muscles that control the position of the pelvis and overall stability of the leg during the running stride. Weak hips also contribute to the pelvis “dropping” down on the non-stance leg.

All this talk about the position of the pelvis is critical. Because when your pelvis moves into an unfavorable position, the IT band pulls away from the knee.

ITBS is a problem with excessive, abnormal movement of the pelvis that must be controlled.

And how do you control excessive movement? By strengthening your supporting musculature to handle the impact forces and torque of running. While strength workouts are incredibly helpful, they’re often the strategy that most often gets skipped.

Exercises for IT Band Syndrome

Strengthening the hips and glutes is the most valuable treatment strategy for IT band syndrome. These muscles will control rotation of the femur, position of the pelvis, and ensure the IT band is not compressed or “pulled away” from the hip.

The video below showcases the ITB Rehab Routine, a series of 10 exercises specifically designed to treat ITBS. The only equipment you need is a piece of rubber tubing, also called a therapy band, for extra resistance.

The Exercises:

Side Leg Raise: Lie on your right side and lift your left leg as high as you can—no more than 45 degrees—in a controlled manner, then lower it back down to the starting position. Make sure your pelvis remains in a neutral position and your butt is forward so you maintain a straight line. Don’t let your hips fall backward so you start engaging your hip flexors on the front to lift higher. A more advanced version includes a loop of rubber tubing around your ankles for added resistance. Perform 20–30 reps.

Clamshell: Lie on your right side with your knees and ankles together, with knees bent at about 90 degrees. Open your legs by activating your upper glute muscle. Make sure you maintain a neutral spine and don’t rock your pelvis.  Keep the motion slow and controlled. A more advanced version includes putting a loop of rubber tubing around your thighs just above your knee. Perform 20-30 reps.

Hip Thrust: Lie on your back in a bridge position with your weight balanced between your upper back between the shoulder blades and your feet which are flat on the ground. Keep your arms at your sides or cross them over your chest. Lower your butt almost to the ground and thrust upward by activating your glutes and driving your heels into the ground. A more advanced version is the Single Leg Hip Thrust. Lift one leg so your weight is all on one leg and your back. Repeat the same movement, making sure you drive your heel into the ground and keep a stable pelvis. Perform 20-30 reps.

Side Hip Bridge: Lie on your side with your feet propped on an elevated surface about 1-2 feet off the ground. Push your bottom foot down and lift your torso using your hip muscles while keeping a stable spine. Return to the starting position. Perform 10-30 reps.

Side Shuffle: With your knees slightly bent in a squat-like position, take ten steps to one side. While still facing the same direction, take another 10 steps back to your starting position. This is one set. A more advanced version includes a Thera-band or loop of rubber tubing around your ankles. It should be tight enough so it provides constant resistance during the entire movement. Perform 3-5 sets.

theraband monster walk
photo: Brian Fullem

Pistol Squat: Standing on one leg, squat down so your thigh is almost parallel to the ground. Keep your spine in a neutral position and keep the motion slow and controlled, ensuring your knee does not collapse inward. Perform 5-15 reps.

pistol squat
Photo: Scott Draper

Hip Hike: Stand on your right foot. With your pelvis in a neutral position, drop the left side so it is several inches below the right side of your pelvic bone. Activate your right hip muscle and lift your left side back to its neutral position. Perform 10–30 reps.

Remember these pointers while doing this strength workout:

  1. If you currently have ITBS, perform this routine every other day.
  2. Modify the number of reps or take extra time in between exercises if necessary.
  3. If you don’t currently have ITBS, do this workout weekly for injury-prevention and to enhance your stride effectiveness.
  4. Start with low or medium resistance bands and move to a stronger resistance when it becomes too easy.

Remember that this routine is not a full treatment program for IT band syndrome. If your pain is severe and prolonged, seek medical treatment. For most runners with a minor case of ITBS, however, these exercises will help get them back on the road within 1-2 weeks.

Now get stronger, stay healthy, and good luck with your training!

Updated from article originally published March 2015