ITB Syndrome: How to Make Your Physical Therapist Miserable by Fixing Your Own Knee Pain

ITB syndrome really sucks!

And yes- I have probably sent my physical therapist’s kids through college with the amount of sessions I have had over the years to loosen up my tight leg muscles to ease off my dreaded ITB syndrome.

Not to mention a few doctor’s appointments and scans to check there was nothing actually “wrong” with my knee.

Why could someone not just “fix my ITB syndrome”?

Those who have had runner’s knee will be nodding in sympathy.

For those who have not had the pleasure- it is called iliotibial band(ITB) syndrome. It is an insidious knee pain, usually felt on the outside of your knee when you run that starts as a niggle then gets worse and worse and worse until you are really limping and cannot run.

If you really aggravate it by trying to deny it and “run through the pain” it may last a few days.

If you try to “rest” it, the knee pain eases temporarily but the problem does not go away. As soon as you go back to running- it is still there.

You have not had an injury, you have not had any trauma but this knee pain has come out of nowhere!

And is not going away!

Is There A Cure For ITB Syndrome?

The short answer is YES- there IS a cure!
I suffered on and off with this for about 3 years which really interrupted my running progress. I had to stay running very short distances only as whenever I tried to increase my mileage, my knee pain would flare up again.

I tried all sorts of treatments:

Heat rubs did nothing
Wishful thinking did nothing
Rest did nothing
Stretching did nothing
Sports massage helped temporarily
Acupuncture did nothing
Medication only temporarily blocked the pain but did not solve the problem

At times, over the 3 years, I gave up running completely in frustration.

But it just did not make sense! I could cycle hard for 100 miles with no twinge or pain in my knee.

So surely there was nothing wrong with my knee?

Also there was no damage at all on MRI scans or X-Rays so WHY did I have knee pain?

ITB Syndrome Cure: Identify The Problem

Eventually, I worked with a physical therapist who actually understood the problem, and had a cure. She wanted to actually help me fix the problem, not just ease it off for a week or two.

Note the key phrase- “help me fix the problem”.

She could not do it for me.

She could not “click something back into place”.

She could not give me a magic pill.

I had to do some work to re-correct the way I ran and strengthen certain muscles that were not in balance or not active enough.

Of course I was more than happy to do this. I had been searching for 3 years for an answer. I just needed to know what to do!

But…once I did this, I was free! And it only took around 8 weeks- I could not believe it and was a little miffed that it took so long to get to the right answer.

I could build up my running gradually and have since run marathons, triathlons and ultras.

No tweaks, no twinges, no more knee pain, no holding back the pace or distance and no more physical therapy appointments.

**The problem is caused by the way you run**

Once I understood this it all made so much sense.

If you do not address your gait, your alignment and the way you run, you will always have knee pain and ITB syndrome.

If you watch the video closely, you will see the pelvis drop on one side as the runner lands. This indicates weakness in the gluteal muscles. When we run the pelvis should stay level. When the gluteal (butt) muscles are slightly inactive, it causes more reliance on the ITB. (This is a tissue that runs from the hip to the outside of the knee. It is a support structure to the leg).

The ITB then has to overwork and the knee tends to roll in a bit.

Sometimes this is exacerbated if your foot over-pronates and your arch collapses.

Sometimes it is exacerbated if your inner quadriceps are weaker than your outer quadriceps.

There are lots of nuances that may occur to exacerbate the problem but in 99% of cases the gluteal muscles are weak and not doing their job of strong hip extension and controlling pelvic stability.

Gluteal weakness is commonly seen in runners with ITB syndrome. In my clinical experience, once you develop strong gluteals and optimise your running gait, you will never have this knee pain again.

Why did no one tell me this before?

I know it is so frustrating.

Sadly not every doctor, not every physical therapist knows enough about it.

Unless you see this problem a lot, you will not know how to fix it successfully.

Unless you understand how to gradually re-train the way you run, you will not treat it successfully.

As most of you know who work with me, once I was shown how to activate the right muscles and improve the way I run, I was so impressed, I actually studied and became a sports physical therapist.

I work with a lot of runners and triathletes on this very problem.

I am shocked at the number of young, healthy, fit people who come to me saying things like:

“xyz therapist told me I need to drink more milk to fix my knee pain”

“the doctor said no one over the age of 30yrs should run”

“running is bad for your knees”

And many more destructive urban myths that simply are not true.

It is important that you, as the runner take control of this problem. You must understand how to strengthen the right muscles and gradually how to change the way you run. It is only subtle.

Think of it more as “optimising” rather than changing. Tweaking rather than starting from scratch.

Gluteal muscle strengthening and a few small changes in the way you run will fix this condition once and for all.

Conversely all the other treatments- like foam rolling, massage, ultrasounds, ice and taping may help temporarily but will not permanently solve the problem.