IT Band/Knee Pain

Jill B.

Barefooters
Oct 11, 2010
21
0
1
Does anybody have IT band issues that result in knee pain? How did you resolve it? I can't run more than a mile before I have to stop and limp home...I'm so bummed.
 
Jill, first of all--I'm SO

Jill, first of all--I'm SO sorry you're dealing with this. IT band pain (or "ITBS," Iliotibial Band Syndrome) can be very, very frustrating! But you CAN get past it.

I've dealt with ITBS for about a year, on and off. Now I'm at the point where it's under control. It seems like my IT band tightens up very easily, but when it does I know how to get past it quickly, so it's manageable. I know how to prevent it--it's when I don't do what I need to do, that it tightens up. And I'm continuing to work to get STRONGER and LOOSER so I can get to the point that this is no longer an issue for me.

My suggestions:
  • Find a really good physical therapist, preferably one that teaches you how to effectively "roll" your legs & glutes with a foam roller & massage ball or tennis ball. "Rolling" is a type of TRIGGER POINT THERAPY, and if you Google that term and your city, hopefully you can find someone who implements that into their practice. (In my area, it's a physical therapy place that does a lot of their work with athletes.) Trigger point therapy (including rolling) helps to loosen up the muscles that attach to the IT band. When these muscles get tight (which commonly happens with runners) the IT band can respond by getting tight & inflamed, and it then pulls on your knee. Interestingly, some of my ITBS has been due to gluteal tightness--amazing how my butt can make my knee hurt! :) My physical therapist also did Active Release Technique, which was meant to get rid of some of the tightness I can't get with a roller or ball.
  • Incorporate effective rolling of the quads, IT band, and glutes, EVERY DAY. You should do it at least twice a day while you're getting past this, and keep doing it every day for a LONG time. If I skip one day I'm usually okay but if I skip a few days (like when I was sick and sedentary a couple of weeks ago) I can expect my IT band to tighten back up. Rolling effectively and consistently is CRUCIAL to me and keeps my ITBS under control. The last two times it flared up on me, it was because I'd had multiple days of little or no rolling, combined with being sedentary those days.
  • Do strengthening exercises. My physical therapist gave me specific exercises for strengthening those muscles in my hips that weren't effectively supporting my legs when I run. He told me my quads & hamstrings were plenty strong--but my hips needed more stability.
  • Focus on form. The first link below has info I found on Chi Running that I've incorporated into my form as much as I can--it's all about pelvic stability.
  • Lastly, I don't do a lot of static stretching but I find that if my IT band is tightening up during a run, sometimes I can get past it by stretching the IT band (which is by then warmed up.) Doesn't always work, but sometimes does. There are plenty of IT band stretches online; just Google it.
There are three really good threads on this board about ITBS. I'd definitely suggest you check them out. Here are links to them:

My IT band is winning (and I'm determined not to let it) This is the thread I started a few months ago. It's really long but has LOTS of good info in it. If you are looking for good exercises, scan for Jimmy's posts; he is a professional & has great advice.

Knee pain, not sure if it's ITB...please help! If you're looking for more specific rolling advice, I give some in the 4th post of this thread.

Do VFFs increase the chance of IT Band syndrome? Interesting thing to think about--you can read some different opinions on whether or not you should be purely barefoot as opposed to wearing minimalist shoes. (I'm not sure if you're shod or not right now.)

I would just encourage you not to get too discouraged. This is something you can get past, and thankfully you don't need surgery or anything to get past it! That being said, your IT band is in the habit of tightening up, and it can take quite awhile to get strong and loose and retrain that thing not to tighten up. For awhile even as you're improving, you may have no idea, every run, if it'll bother you or not. It DOES get better. I feel like I have really gotten to know this area of my body. I'm looking forward to the day when my IT band doesn't ever bother me, but until then...just being at the point where I know how to manage it, is a HUGE improvement for me! I've run 2 half marathons and one training run of 13.3 miles in the last few months, and while I did have to do some stretching and/or rolling (with a massage ball) during those runs, my IT band never cramped up. You can get past this--but I'd suggest you make it easier by finding a good physical therapist or other pro who works with a lot of runners!
 
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Great post Beth!  Beth is our

Great post Beth! Beth is our resident ITBS expert. We have watched her go through this for months now and come out better on the other end. I'm sure her advice is sage.
 
Beth!  I could kiss you for

Beth! I could kiss you for this! Thank you so much. This knee pain is a totally new thing for me....it just popped up a couple of weeks ago.

I had a massage therapist work on it last week....holy youch! I've started foam rolling it too....holy youch! And I JUST picked up a copy of Chi Running yesterday.

For you, do you remember anything that might have triggered it? (weird question?) Over the winter I started running in a new pair of minimalist shoes. After my first run, my knee kinda felt weird, but didn't hurt like this. It went away and didn't bother me again until a few weeks ago....and wow did it hurt! I also started running for the first time on a treadmill this winter...that didn't feel so great either. I'm looking for something to blame here....haha!

~J
 
Jill--Glad it helps! Be sure

Jill--Glad it helps! :) Be sure to check out the specific rolling techniques that my physical therapy place taught me. (See that 2nd link.) It really is so much more effective for me than just plain rolling.

For me, the only trigger I can point to for when it first bothered me, is higher mileage--and it wasn't very high at all. I got it when I first started running; then it came back when my mileage was getting higher; then it came back after I started running BF/minimalist when I was building my mileage up again. I think I started out as a runner with weak hips & bad form, and this was just waiting on the sideline to jump in and start bothering me once I hit some magic mileage number. :)
 
Good advice Beth.  My

Good advice Beth. My troubles with ITBS have taken me on a different path than the more traditional one Beth suggests. Just thought I'd mention it. As you've probably seen from the threads she posted, there are a lot of different ways to deal with the syndrome, and everyone is different.

Most importantly, I want to point out that ITBS isn't caused by a tight IT band. Your IT band is a tendon...it doesn't do much in the way of getting tight. And no amount of stretching or massage will make it loose. ITBS is an inflammation of the muscle or tissue in that area. Stretching and massage help to alleviate some of the pain, but there is only so much you can do without further aggravating the condition. In my opinion, most if not all IT band stretches are a bunch of B.S., especially those that are supposed to stretch the band itself.

So while I agree with Beth's solutions, the most important point to effective recovery is reduction of inflammation. You're not going to get that with anything except Rest, Ice, Compression, and Elevation. I can't stress any point more than the REST part. You can't run through this injury. I repeat. YOU CANNOT RUN THROUGH THIS INJURY. Rest, rest, rest, and then more rest is the most effective cure.

Once your leg is feeling a little better, you can run again, but at a significantly reduced mileage. I went from 40 miles per week to 10 miles per week, and built up slowly from there.

Another thing you can do as your leg feels better is incorporate the strength training that Beth mentioned. I have come to prefer yoga over strength training for this condition though, because it's hard to get good balance of the muscles through most of the prescribed exercises for long term prevention of ITBS.
 
Switching over to running

Switching over to running primarily barefoot is what cured mine. It took about two months for it to fade completely but it has been well over a year now since I have had any pain in that area.

I should also note that once my IT pain was gone I started doing more strength training, which may have played a part as well.
 
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I agree that more strength

I agree that more strength training and less running is good for your ITBS, as long as you're doing a balanced program like Crossfit. Just adding strength training to your running will probably just make it worse.

I prefer yoga right now because it's harder to use bad form and aggravate your knee further.
 
Excellent description of what

Excellent description of what ITBS actually is, saypay. Thank you!

It's interesting to me that I have gotten ITBS due to various muscles being tight. First when I got it, it was my quads. Later, my glutes. Recently I've even noticed when my hamstrings are tight, they can lead to ITBS. Basically, I have to keep my whole upper leg loose or else I feel it in my IT band.

As far as running through it--what I've heard is you can run, but when it starts hurting, STOP. And if you can hardly run at all without it hurting, you probably need (as saypay suggestied) to stop running & get the inflammation reduced first, because having to stop every run after a mile is just plain frustrating.

I've become really sensitive to that area--I can tell the difference between some tightness/achiness, and that OUCH inflammation. I can run through a bit of tightness, but when it REALLY gets inflamed I have to stop.
 
So many muscles attach to the

So many muscles attach to the IT band, I'm not surprised that your hams were tight C.Beth.

My favorite IT band stretches are actually yoga poses. This is an excellent yoga progression I found online for IT band pain.

http://link.brightcove.com/services/player/bcpid416421194?bctid=68928548001

The key to good IT band stretches for me is to find something that doesn't require you to lock your knees. The traditional cross-legged forward bend thing isn't for me, because locking my knee like that actually makes my leg more stiff. I especially like the hip openers on that video.
 
Hey there,ITBS is something

Hey there,

ITBS is something I see often in my work (I teach restorative, post-PT Pilates) and have seen many clients get past it successfully. I agree with SayPay that it's good to hold off running for a while and a great time to do some kind of strength training that involves lengthening like Pilates, Gyrotonic or yoga. I usually tell clients to think of ITBS as a kind of growing pains telling you to develop some different muscle groups - you'll know that you're in better shape when it goes away. When it comes back it's time to get back to work.

The iliotibial band connects to the hip below the gluteus medius on one end and the knee on the other, so when it's not happy, the knee probably won't be, either. When a person's IT bands are inflamed, generally it's good to look in three places, their gluteus medii (the muscles on the sides of the hips above the ITB that fire when the foot presses down into the ground), their deep abdominals/pelvic floor connection, and the muscles on the insides of the thighs and calves.

In other words, when a person's IT bands are overworked, it means that there's too much pressure going along the outsides of the legs instead of the centers because the parts that should be doing the work on the insides aren't and the IT bands take up the slack. Check to see if your feet are rolling out too much at the arches when you run. Notice when you run and walk if your feet have too wide of a stance. A runner with too wide of a stance and a weak inner line will very likely tip the hip when running.

For rolling the legs, I usually recommend a softish 6"-8" massage ball instead of a roller for people whose IT bands really hurt. It's a slower process, but it actually feels good instead of painful to roll, so you're more likely to want to do it more often. It's also less likely to mess things up than a tennis ball or roller. Also, don't just roll the IT bands. Roll the quads, hams and inner thighs, too. Make sure when you roll along the IT bands that you go all the way up to the meaty part of the outsides of the hips to help wake up the muscles there (the gluteus medii). I like Yamuna Zake's "Body Rolling" techniques - they relax muscles and fascia as they help to cue up hard to access muscle groups. C. Beth's post here had some good rolling tips (scroll down).

Some ITBS folks also have very tight spots in their backs which often points to deep ab weakness. See below for some exercises. Try rolling your feet and calves out, as well, on a tennis ball or something similar, since it helps to "turn on" the right muscles and relax the parts of the body that are in the most direct relationship with the ground.

Here are some core exercises that help ITBS:

1) Inner thigh connection to abs: Lie on your back with your knees up and feet flat on the floor and parallel. Put a ball between your knees that lets your thigh bones be parallel to your hip sockets. Squeeze the ball to about 30-50% effort with the inner thigh muscles as you exhale, firing the deep abs so that the belly drops down rather than pooches out. Try not to activate seat or back muscles. Ideally keep the pelvis stable, neither tilting or arching it.

2) Pelvic Bowl strengthening: Lie on your back with that same ball between your knees. Imagine your belly is a bowl of water. Slosh the water towards your ribs as you gently breathe, then slosh it towards your tailbone, letting your pelvis rock. Avoid using seat or back muscles. Make sure that the belly flattens instead of rounds (for all these exercises).

3) Bridging: As you gently squeeze the ball, tilt your pelvis like in 2), then press with your feet, fire up your glut maxes and lift the pelvis up without using anything but inner thighs, abs, glutes and hamstrings. If your hamstrings cramp, bring your feet closer to your hips and see if you can get your glutes to do more work. If your ITBs fire, choose a smaller ball and move the feet and legs closer together.

You can also try this exercise on one leg at a time. It's harder, but also a good variation to get to the gluteus medius. Try alternating lifted legs while staying up in bridge. That mimics the way the pelvis stabilizes mid-gait.

For a more advanced version of the inner thigh and bridge exercises, get a thick pillow that you can fold in half and wedge between your knees or a bigger ball, and squeeze it with 50-75% effort between your knees as you lift the pelvis up in a bridge. Make sure that the lower back muscles/ITBs are relaxed as you lift and your glutes are firing up a storm.

I'm looking at this note and realizing how confusing it looks without pictures. I apologize - I hope it was helpful. If you have questions, please feel free to ask.

I hope you feel better soon!

Jen
 
Jen--AWESOME information!!

Jen--AWESOME information!! Thank you for sharing your expertise!
 
Jennifer--Mine's doing pretty

Jennifer--Mine's doing pretty well right now. It tightened up when I was sick (and very sedentary) recently but I was able to work out most of the tightness within a few days. Haven't had any big problems on my last few runs.
 
Thank you all very much.  I'm

Thank you all very much. I'm starting yoga next week and taking next week off from running. Right now my knees feel great...nothing hurts going up and down the stairs. The foam roller is feeling less and less like torture. I'm keeping my fingers crossed.
 
Jen, i just finished my

Jen,



i just finished my yoga stretch minutes ago after my run. I'm wondering if it's a full bridge or do i leave my shoulders on the ground?





mike
 
Hey, Mike,The bridge I

Hey, Mike,

The bridge I described goes up to the bottoms of the shoulder blades so that the torso and legs form a kind of plank shape. Keep the effort in the abs, then inner thighs, glutes and hams in that order, everything from the ribs up should be soft, relaxed and grounded. Try not to bear down in the ribs or neck. The movement should flow and be nice and slow, going from neutral spine (soft back, heavy tailbone on the floor) up to the plan position and back down to neutral again.

The "half wheel" bridge in yoga's also valuable, but it's very easy to splay the legs, which means that you're not countering the IT bands as well.

Have a good run!

Jen
 
jen, i'd like to know more

jen, i'd like to know more about the massage ball you mention-what it is and where to find one.

i have ITBS issues also-i think i do anyway! last weekend i overdid it-ran/walked for just about 30 minutes in my new merrell pace shoes and was so stiff the next day could barely walk! mainly knee/hip pain. have taken it pretty easy this week, but am so anxious to be able to run pain free again!
 
svgreengoddess: The balls I

svgreengoddess: The balls I like the best are made by Yamuna Bodyrolling. You can find them here: http://yamunabodyrolling.com/store/. The silver one is harder than the pearl, but both are 6". The gold one is the 8" ball, which is soft like the pearl, and considered good for "beginners". You can get a how-to book from them, as well, which is helpful if you're new to rolling.

I also have a rolling routine of my own for ITB issues which I'd be happy to give you, with the consideration that it's sans pictures, through an on-line forum, and a work in progress. If you'd like to try it, I'd be interested in getting some feedback on it.

The 6" or 8" toy balls you can get anywhere are fine, too, but less hardy and softer than the Yamuna balls. My issue with Yamuna is, of course, their price. I just did a quick search on OPTP and found these: http://www.optp.com/Balls-for-Body-Work-Series.aspx. I'm guessing they're probably as good. Be sure to get a pump when you get the ball.

I'm curious, do you think how you were running in the shoes made a difference? Do you generally do the same amount barefoot without a problem? If you think it was the shoes, can you tell what it was about them that changed things?

I hope you feel better soon!
 
thanks for the info on the

thanks for the info on the balls jen, i'll check those out. regarding my knee pain and whether it was from the pace glove shoes or not-very hard to say. besides being new to this, i've been dealing with ongoing pain already even w/o the running.

i used to run regularly in non-minimalist shoes (before there was such a thing!) a number of years ago, so i think my body is going thru an adjustment in general with the increase in exercise. i had to completely lay off last fall due to hip bursitis. i'm also about 35 lbs overweight, (and in my mid-50's) which doesn't help! i'm hoping to eventually find a barefoot running coach in my area. i have no idea if i'm successfully transitioning to a forefoot strike rather than heel striking. i'm also really slow and i read something recently that said that if you "jog" rather than run it's harder to avoid the heel strike.