The Dos, Do-Nots, and How-Tos for IT Band Syndrome

IT band syndrome is typically – but not always – an active person injury. We see it a lot in runners, cyclists, and occasionally CrossFitters. It’s also more common in those that have hip pain. I (Dr. Sarah) have struggled with it on and off over the past two years, so I get that it can be a real pain (physically and just flat out annoying).

Ironically, it’s also one of my favorite diagnoses to treat because it responds so well to hands-on therapy (dry needling and cupping are my go-tos here). When a client comes in with IT band syndrome, I prioritize hands-on treatment on day one and get them feeling better immediately. Then, on the second day – or if there’s time at the end – we run through the basics of IT band syndrome, what to do, what not to do, and get started on exercises.

This blog post will focus around all the stuff we talk about on day two. We’ll touch briefly on what we do on day one at the end (scroll down to see Dr. Emily needling Dr. Sarah), but we’ll focus mostly on what you can do on your own here.

Do I Have IT Band Syndrome?

Before we go about solving IT band syndrome (ITBS), it’s wise to make sure it’s really ITBS that we’re dealing with. It can present a variety of ways so it’s not always a cut-and-dry diagnosis. Here’s what you’ll want to look for –

• Pain near the outside part of your knee (may be above, at, or below the knee)
• Pain with using your leg (running, squatting, cycling, etc.)
• Pain typically worsens as activity duration or load increases
• Pain may radiate up to hip, towards the inner part of the knee, or down the outside of the calf

What Not To-Do for IT Band Syndrome

IT band syndrome is a soft tissue (muscle, connective tissue) injury that is due to too much compression on the IT band. This means that adding further compression – while it may feel good in the moment – does not help in the long term. We would go so far as to say that if you continually add compressive forces to a compression injury, you’re likely going to make it take longer to heal. The two most common things we encourage individuals with ITBS to stop doing are foam rolling and stretching.

Foam Rolling

Once we explain that ITBS is a compressive injury, it’s not hard for most folks to understand that foam rolling isn’t going to help. Foam rolling is simply smashing on the IT band. It’s about as compressive as you can get and therefore isn’t the best option.

On the flip side, cupping is a decompressive technique. It literally pulls apart the layers of the tissue and brings water between those layers. This is exactly why cupping is so effective for ITBS – it decompresses an area that is compressed.

Stretching

This is typically harder to convince clients to stop doing. Stretching is supposed to be good for you, right? Well, here’s the thing – you can’t actually stretch the IT band. Now, we are well aware that you’re going to find plenty of people on the internet who will disagree with this.

And, we are very comfortable saying that it is impossible for a human to stretch their own IT band. Why? Because it takes 925 kg (over 2,000 pounds) of force to stretch the IT band. See the article called Three-Dimensional Mathematical Model for Deformation of Human Fasciae in Manual Therapy in JAOA if you don’t believe us.

Now, that’s not to say you aren’t stretching the muscles around the IT band. Stretching those muscles may have some benefit – for a different diagnosis. When you stretch a muscle, you pull on it. Pulling on a muscle produces a compressive force on the structures underneath the muscle. These structures are already irritated in IT band syndrome. So, even if you could stretch the IT band, we’d argue that doing so isn’t going to be helpful.

What To Do About IT Band Syndrome

We’ve talked a lot thus far about what not to do, but equally important is what you should do when you have ITBS. The mainstay for treatment is hands-on techniques as well as strengthening of the involved hip and quad muscles. Exactly what muscles are involved will vary from person to person, but there are certain muscles that are typically involved. We’ve included a few videos of our go-to exercises below.

Hip Strengthening

Modified Side Plank Hip Abduction

Contralateral Hip Elevation

Quad Strengthening

Spanish Squat

Heel Elevated Squats

If None of that Works for IT Band Syndrome

Here’s the thing – we’ve seen people who have internet searched, done everything right (all the above stuff) and still have IT band syndrome. Unfortunately, IT band syndrome is one of those diagnoses that sometimes doesn’t do as well with exercise. Fortunately, it does exceptionally well with hands on therapy, most notably dry needling and cupping. If you’ve never had dry needling done before, give this 47 second video where Dr. Emily dry needles Dr. Sarah for ITB syndrome a watch.

Disclaimer: It’s hard to educate while someone is poking you with needles, so my thoughts do trail off at one point.

Wrapping Up IT Band Syndrome

In a nutshell, ITBS can present quite a few ways, but it’s typically an active-person injury that causes pain around the outside of the knee. While it may initially seem counterintuitive, stopping stretching and foam rolling both assist with healing. Strengthening the quad and hip muscles also promote healing. And, if things simply aren’t getting better, it’s time for some hands-on therapy, as this is one of those diagnoses that does really well with a bit of TLC.