I chronicled my IT band injury in real time while I was recovering, but I know when I was dealing with the injury, all I wanted to read online were success stories. So I decided to write up an overview post about my IT band injury and recovery.
My IT band injury originally sneaked up on me while I was training for my marathon. I had felt some knee pain here and there during my long runs, but it wasn’t anything overwhelming. And it’s normal for me to have some niggling pains at the end of longer runs. The first time it was anything more than that was during a 15 mile long run a couple months out from my marathon. During the last several miles of my run, when I stopped for a stoplight, it stiffened up. The first 5-7 steps after were quite painful, but once it warmed up again, it was fine. It was sore the day after the run, too, but I had treated it with ice and ibuprofen and it was fine two days after the run. Over the next few weeks, my knee would occasionally hurt during or after runs, but never badly enough that it worried me. And the pain was always gone within a day, so I figured it was regular long run soreness.
Finally, I had the fateful run that pushed my knee over the edge. It was a 15 miler during the first week of my taper. My knee hurt starting out (which wasn’t unusual), but it never loosened up. I tried to keep running, but after 8 miles, I knew it wasn’t going to start feeling any better and that I might injure it more, so I called it quits and hitched a ride home.
After doing some Googling, I determined it was my IT band. The big giveaway was that my knee hurt less the faster I ran. I tried to run a bit during the next week, but unlike in the past when my knee would rebound, it continued hurting. Because I wanted to run my marathon in a couple of weeks, I decided to go the “rest” route until then and try to treat the injury with strengthening exercises after. I stayed off the roads and did pool running and the elliptical for the rest of my taper. Additionally, I changed the way I sat at work and stopped wearing shoes with any heel at all. The marathon didn’t go well (I think I was compensating for my knee which messed up my go-to stride), but my knee did hold up pretty well. It hurt a bit during, and it was stiff and sore afterwards, but it didn’t hit the level of pain I’d had a couple of weeks before.
After my marathon, recovery was the name of the game. I had read a lot about IT band issues sticking around and causing problems for months. I didn’t have time for that because I was scheduled to start my Ironman training plan in just over a month. So, once I started working out again, I started strength training. I did this part on my own. I looked up exercises for hip and glute strength since that seemed to be the most common cause for IT band pain and started doing an hour and a half of strength training a week. I also scheduled a free running analysis with a local PT clinic. The physical therapist gave me some solid advice on my stride (increase my cadence and focus on a mid-foot/toe strike instead of heel strike) and suggested that I come back in a couple of weeks if I didn’t have any improvement.
I was very careful with me knee for those two weeks. I stopped running the minute my pain felt even a little bit sharp (as opposed to achy). Still, even with the continuing strength work and the changes in my form, I didn’t see much, if any, improvement over the next couple of weeks, so I called up the physical therapist and made a real appointment.
The physical therapist did a litany of strength, flexibility, and stability tests on me. It turns out, my hips and glutes were actually pretty strong. However, when I tried to actually use them, my stability was lacking. Even worse was my flexibility. So those two things—stability and flexibility—were what we worked on during my relatively few sessions of physical therapy. Just a few weeks later, I was able to run an hour and a half with no pain at all.
Looking back on my experience with IT band pain, there are a few things that stand out as important to my recovery. Here are my suggestions if you are having IT band pain:
1. Strengthen. Weak hips and glutes are the most common cause of IT band pain. Since “graduating” from physical therapy, I’ve been faithfully doing my strength work three times a week. I do two shorter 15 minute sessions and one longer 30 minute session. My physical therapist suggested that I focus on a few different exercises. My physical therapist specifically had me focus on exercises that used lateral movement. Because swimming, cycling, and running are all forward-motion sports, the muscles responsible for lateral movement can get weak or ineffective. Specifically, he recommended I do the following three exercises:
2. Improve flexibility. I didn’t see much about this particular issue online. Sure, I saw suggestions to stretch the IT band (or rather, the TFL which is the muscle that attaches to the IT band), but I never saw anything about how a lack of flexibility in other muscles could contribute to IT band pain. My physical therapist had me stretch my hamstrings, my calves, my glutes, and my TFL several times a day. While I have slacked off on the stretching, I still faithfully stretch (and do leg swings) before every run.
3. Take care of your knee in your everyday life. This made a big difference once I started doing it. I am chronically wiggly, so I cross and recross my legs every few minutes. I sit cross-legged or on my knees. My legs are always sticking out at weird angles. But I noticed that this was putting completely unnecessary stress on my IT band. So I forced myself to sit with my legs out in front of me. I stopped wearing any heel at all. Anything that made my knee hurt even a little was discontinued or modified. For instance, I noticed that for some reason, kneeling on the kneeler/hassock at church put some undue pressure on my IT band. So I modified the way I kneeled so that I put all my weight on my good knee and let my bad knee just relax off to the side.
4. See a physical therapist. You’ve probably noticed that I talk about my physical therapist a lot. I think I had 4-6 sessions in all over the course of a month. I know not everyone has the financial opportunity to see a physical therapist, but if you do, I would suggest it. I am so glad I didn’t spend three months doing almost the right thing while trying to completely self-treat. I did the best research I could and put together a pretty solid strengthening plan, but I didn’t pick out the perfect exercises for my particular situation, and I missed the flexibility part. Additionally, my physical therapist used a massage-type technique on me called ASTYM™ that I would not have been able to do myself. I’m not convinced this was the integral factor to my healing, but it was likely helped.
5. Improve your running form. Everyone has some form weaknesses, and those can contribute to injuries. So do what you can to improve your form and take some of the impact off your joints. For me, it was as simple as increasing my cadence. Once I increased my cadence, I automatically switched to a mid-foot/toe strike instead of a poorly executed heel strike that was creating more impact for my knee than I should have been.
Above all, I would advise anyone with any sort of significant IT band pain to act quickly. If a little bit of rest doesn’t clear the problem right up, then be proactive. Don’t just foam roll. Do strength exercises. Read up on running form and consider where improvements might help reduce the impact of your footfall. Continue to take it easy on your knee as you build strength. If the improvement doesn’t come, then consider seeing a physical therapist (if you can afford it). It’s a pain in the neck, and it’s not all that cheap, but a physical therapist will be able to give you advice that is specific to your particular body and your particular injury.
For further reference, here are the posts that detail my IT band injury and recovery: