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Introduction

IT Band Pain, officially known as iliotibial band syndrome, is pain on the outside of the knee and one of the most common injuries amongst runners and can be a frustrating injury if not managed correctly. However, if managed correctly you should be able to get back to running safely and effectively.

Signs and Symptoms

IT Band Pain is a compression underneath the IT Band onto the bone. Common signs and symptoms may include:

  • Pain on the outside of the knee

  • Pain when descending stairs or walking downhill

Causes

1. Sharp increase in training load (especially long runs)

The most common cause of IT Band Pain is increasing your training load too early too soon. When running, you want to make sure you are increasing your weekly mileage, the length of your long runs and the number of runs that you do per week steadily. For your weekly mileage, you should look to increase this no more than 10% per week and your days per week no more than once when starting a new plan. Sharp increases in your training load (e.g., jumping from running once per week to three times per week) can put excess strain on your body, including your knee, which in turn can result in IT Band Pain.

2. Running downhill or on uneven surfaces

If you're frequently running on hilly or uneven terrain, this will tend to move the knee more and put extra stress on the outside of the knee where the IT Band connects, leading to increased sensitivity.

3. Peak adduction angle

When you run with your knees too close together and a narrow stride, it can create additional tension on the outside of the legs, especially around the IT Band as the knee drives across the body.

4. Underlying strength

When runners have a deficit in quad and hip strength, this can lead to the knee taking an increased load during running.

Treatment

1. Decrease your training load

When returning to exercise, you should adapt the traffic light system so ensure you are are not delaying your recovery. If you get any pain in Amber or Red, it is advised that you stop running as this will likely delay your recovery.

Green = 0-3 pain, Amber = 3-5 pain, Red = 5+ pain

In the short-term, make sure to take time away from running to let your shin pain reduce. Stay active with activities such as walking and cycling, but avoid high impact sports. Once your pain has subsided, look to gradually build back into running with some easier runs until you are able to run comfortably without pain. You can adjust the number of runs per week, or your running ability, easily from within the Runna app and your plan will adapt accordingly.

2. Keep your runs on the flat

As running downhill and on uneven terrain can put excess stress on the IT Band, try to keep your runs on the flat and on flatter surfaces such as pavements or paths.

You can even explore using a treadmill on 2-4% gradient which will lower the force through and on the outside of the knee even more. Be aware though that this will put more stress on the calf and Achilles so listen to your body and drop from running down to a fast walk if needed.

3. Increase your stride width

If you have a particularly narrow stride, it can be helpful to increase your stride width and improve your running biomechanics. Try to bring your stride a little wider, helping to reduce the tension on the outside of your knees.

4. Increase your quad and hip strength

As well as the above, you should look to build up control and strength around the quad and hip. Watch the video above for the full tutorials.

Side-lying hip abduction (source)

Hip abduction strength is important and runners that experience IT Band Pain often have reduced strength in this area. Lie on one side with your head resting on a straight arm. Roll your top hip forward and straighten your leg, inline with your chest. Lift up your foot perpendicular to your body in a smooth motion and lower back down again. Do 3 sets of 12-15 reps once per day, eventually adding a band or ankle weight to increase the intensity, making sure to decrease the frequency when this is the case.

Standing fire hydrant (source)

Fire hydrants improve your control around your hip. Stand on one leg with a slightly bent knee and tie a resistance band between your legs, just on top of your knees. Bend the other leg to 90 degrees and lean forwards slightly. Rotate your bent knee out to the side as far as you can and back again. The goal here is to keep your straight leg as still as possible to improve your strength and control. Look to do 3 sets of 10-12 reps, increasing the resistance of the band as you get stronger.

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