Reviewed and contributions made by Brandon Engle, PTA
Running is well known for its health benefits - from improved cardiovascular health, weight loss, stress relief and more. But like with any sport, there does come risk for injury, and one of the most common injuries in running is knee pain.
Knee pain can be caused by any number of reasons and felt on the side, front and the back of the knee. If you are experiencing knee pain on the side of your knee, then the IT Band may the culprit. With some insights from your local ATI PT, combined with stretching and strengthening exercises, we can have you back on your feet and pounding the pavement again in no time.
Get Your Free Physical Therapy Screening
Want to discover how physical therapy can help your knee pain? Get a free screening and let us help you start the path to recovery today.
Get My Complimentary Screening
What is IT Band Syndrome?
The Iliotibial Band (IT Band or ITB) is a thick band of fascia that assists in creating knee stability, especially during activity. It extends from the outside of the pelvis, over the hip and knee, and then attaches just below the knee.
IT Band Syndrome (ITBS) occurs when there is increased friction where the ITB crosses the knee joint. It results in condition that causes pain on the outer side of the knee. According to Brandon Engle, PTA and avid endurance athlete, “It’s a condition commonly found in runners and cyclists. This is the result of repetitive knee flexion activities leading to tightening of the IT Band.”
Common Causes of IT Band Syndrome
ITBS results from a variety of possible reasons. Some of these reasons include but are not limited to:
- Improper training/footwear
- Overpronation during stance phase of gait
- Abnormal pelvis tilting
- Bowed legs
- Leg length discrepancy
Whatever the cause, if you are experiencing pain while running, it is first important to stop activity to avoid further injury to the area. Working with a physical therapist or athletic trainer can then help identify the pain source as well as direct you towards the appropriate stretches and exercises to relieve pain and get you back to your regular activities.
ITB Stretches and Strengthening Exercises
Three stretches that are particularly helpful for the IT band include the Figure Four Stretch, the 90/90 Stretch and the Pigeon Stretch.
Figure Four Stretch
The “Figure Four” stretch is a one that releases tightness in the hips, the glutes and the piriformis.
Instructions:
- Lie on your back with your feet flat on the floor.
- Bring your right ankle over the top of your left knee.
- Raise your left knee towards your chest. Then reach through your legs with your right hand and interlace your fingers with your left just below your bent knee.
- Keeping your shoulders on the ground, gently pull your leg towards you until you feel a stretch in your right hip and glute.
- Maintain this position for at least 30 seconds before switching to the other side. Complete 3 times per side.
90/90 Stretch
The 90/90 stretch rotates your hips and stretches them both internally and externally. It is an aggressive stretch and should be avoided by those with a hip impingement, those who have had a hip/knee replacement and those with knee conditions (i.e., meniscus tear or arthritis).
The setup for the 90/90 stretch is very important and can be difficult to achieve, especially if your hips are particularly tight.
Instructions:
- Sit on the ground and place your right leg in front of you at a 90-degree angle in external rotation. Your knee and ankle should have contact with the ground and your right shoulder should be aligned with your knee. Use your right hand for support to remain upright.
- Place your left leg behind you, internally rotated, at a 90-degree angle. To check your alignment, raise your left arm. The shoulder and arm should run parallel with the thigh and the knee, and your ankle should be in line with your knee.
Forward Position - Sit upright with good posture (i.e., core engaged, shoulders back and down). Your knees and ankles should maintain contact with the ground. IMPORTANT NOTE: For those with particularly tight hips, this position may be a stretch all on its own.
- Maintaining an upright position, gently lean forward and hover over the shin. Only go as far as you can without losing position. Do NOT simply fold over.
Backward Position - To work on the internal rotation, lean backwards gently, rotating through the hip rather than the spine.
- Try to reach your previously free hand to the ground for support. If you cannot reach the ground, then use a yoga block or something stable for support. Remember that it is important your knees and ankles maintain contact with the ground and there is no “pinched” feeling throughout.
Pigeon Stretch
The “Pigeon Stretch” is also referred to as “The Runner’s Stretch” because it releases tightness and tension in the hips and glutes that occur from running.
Instructions:
- Begin on your hands and knees, and then bring your right leg out in between your hands in a lunge position.
- Once in a lunge, heel-toe your foot to the left hand and then drop your right foot and knee to the ground. Position your foot between your left hip or left armpit, depending on your level of flexibility.
- Place both hands in front of you for support and then look over your left shoulder to ensure that your left leg straight and is in line with your left hip.
- Maintain this position for 30-seconds to 1:00 before switching to the opposite side.
NOTE: You may lower yourself onto your elbows or even to the ground to deepen the stretch.
While stretching is an important part of injury prevention and the recovery process, it is equally important to perform strengthening exercises. Three helpful exercises include Side Lying Hip Abduction, Lateral Band Walks and Bridges.
3 Exercises for IT Band Strength
These three exercises can help strengthen your IT band.
Side Lying Hip Abduction
The Side Lying Hip Abduction is a great way to strengthen your gluteus medius. This muscle group helps stabilize your pelvis, which keeps the knee from moving inward and the foot from overpronating. As a result, the gluteus medius can help absorb impact and reduce stress on your legs and feet.
Instructions:
- Lie on your side with your hips stacked upon each other. Your top leg should be straight and your bottom leg and arm bent for support underneath.
- Lift your top leg to just beyond hip level (about eight inches) and hold for five seconds before lowering the leg.
- Complete this exercise two sets with ten repetitions on each leg.
NOTE: When performing this exercise, be careful of allowing your hips to rotate forward or backward so that your body remains in alignment.
Lateral Band Walks
Another exercise that works the glutes and is particularly effective in working the gluteus medius. For this exercise, you will need a mini band, which is available online or many athletic stores.
- Place a band around your ankles and stand with your feet hip-width apart.
- Get into an “athletic stance”: keep your core engaged, push the hips back slightly and bend slightly at the knee.
NOTE: The front of your shoulders should line up with your toes. Avoid letting your knees line with the toes or go beyond them. - Take a small step right with your right foot.
- Meet your left foot with your right before stepping out again hips-width apart.
- Repeat this motion for ten steps before changing direction and completing this movement on the opposite side.
- Complete ten reps per side, three times.
Bridges
The Bridge is an exercise that improves overall core strength and is a great alternative to planks.
- Lie your back in a neutral position with your feet planted on the floor.
- Tighten your abdominals and lift your hips off the floor until your knees, hips and shoulders are in a straight line.
- Hold this position for 10-seconds before lowering your hips to the ground.
- Relax and then repeat three times.
While these stretches and strength exercises are important, rest is crucial to proper recovery. Regular foam rolling post-activity can also aid in that recovery as well as help prevent further injury to the area.
IT Band Physical Therapy at ATI
If you are feeling pain or discomfort around the knee but have not experienced a knee injury, then your IT Band may be the reason. Our physical therapists and athletic trainers will assess and treat your knee pain so that you can get back to the activities that you enjoy. Find a location and make your appointment today!