IT Band Syndrome: Form Over Foam


What if IT band syndrome was not caused by a “tight tissue” and what if I told you there was a better and more long term fix to your IT band pain other than the painful foam roller and endless stretching…would you be interested?

One of the most common injuries to plague runners is IT band syndrome. It can come on quickly, and like an unwanted guest, hang around far too long.

If you search for IT band syndrome online you will find a host of articles reporting fixes such as stretching, strengthening, rest, medication, and foam rolling.  First off, no runner or cyclist is going to rest unless mission critical so let’s forget about that one for now. Yes, in the short term anti-inflammatory medications can help to decrease the pain but they don’t actually fix the cause.  

So, that leaves us with stretching, foam rolling, and strengthening….

I would like to add a crucial piece to the IT band puzzle……….Running Form!

First let’s talk about stretching, foam rolling, and strengthening.

IT Band Anatomy and Function

The Iliotibial band is a dense band of fibrous connective tissue that runs from the iliac crest (hip bone) to the lateral eipcondyle of the femur, the tibia, and the distal femur. One of it’s main roles is to provide lateral stability to the knee.

As a connective tissue, the IT band is made up from fibers from the tensor fasciae latae (TFL) and gluteus maximus.  The interesting part here is that these two muscles work together AND against each other in regards to running and cycling.  Let me explain… The TFL typically is reported as a hip abductor, meaning it helps lift the leg away from the midline of the body.  The TFL also works as a hip internal rotator.  So, although the TFL works with the gluteus maximus in hip abduction, it does this while internally rotating the femur.  Internal rotation of the femur during running has been linked to IT band pain and patellofemoral pain.  The gluteus maximus; however, is a key hip external rotator and therefore increased usage of the TFL over the gluteus maximus results in increased hip internal rotation and more strain to the ITB and patellar tissues. 

IT Band Anatomy

The key takaways here are:

1.   The IT band works to provide lateral stability to the knee (so why stretch it)
2. The IT band is directly linked to the TFL and gluteus maximus muscles and increased usage of the TFL versus the gluteus maximus leads to increased hip internal rotation 
3. Internal rotation of the knee during running adds strain to the IT band

Why Foam Rolling Isn’t the Best Answer to IT Band Syndrome

First off, let’s just say that foam rolling hurts!  As a physical therapist, I have no issues with rehab being uncomfortable at times, but pain without substantial gain is unnecessary. Massage and tissue “mashing” are designed to improve tissue quality and release fascial adhesions due to overuse.  Soft tissue interventions, like foam rolling, can be very successful at alleviating the symptoms of IT band syndrome…

…But the fail to address the cause of the symptoms.  This is why many runners go through cyclical stages of train—IT band injury—rest, stretch, foam roll ice—-train—injury—rest…and so on.  You have to get to the root of the problem in order to fully recover from IT band syndrome.

Common Running Form Errors Associated with IT Band Syndrome

If we are looking to end IT band pain for good, it is necessary to pinpoint running form errors that lead to IT band strain.  
The three most common running form erros associate with IT band syndrome are:


Cross-over occurs when you take a step accross the midline of you body while running.  Typically, your feet should not cross-over the imaginary line from your belly button downward.  When cross-over occurs there is an increase in femoral internal rotation and hip adduction.  Additionally, during cross-over, it is more difficult to recruit your gluteus maximus to provide knee and hip stability.  The end result…increased strain on the knee and IT band. 

Crossover Gait Pattern
Cross-Over Gait Pattern Running: IT Band Strain

Femoral Internal Rotation and Pelvic Drop

Previously we have discussed how internal rotation of the femur increases strain to the IT band.  Femoral internal rotation occurs when your knee rotates towards the opposite knee (rolls inward).  This is often coupled with a drop in the opposite hip/pelvis.  These two actions are both controlled by the glutues maximus and medius and increased with overuse of the TFL.  Proper activation and strengthening of the gluteal tissues is essential to limiting pelvic drop and femoral internal rotation.

Pay attention to the right leg during landing.  You will notice how the knee rotates towards the left leg.  This is femoral internal rotation.

Femoral Internal Rotation
Using 3D Motion Capture You Can More Easily Visualize Femoral Internal Rotation and Pelvic Drop

The Best Long-Term IT Band Syndrome Fix: Glute Strengthening and Running Form Training

If we are looking for a cause of IT band strain, we must look at running form. Correcting running form errors such as pelvic drop and knee rotation starts with engaging or activating the right muscles.  Exercise which demand work from the gluteus maximus and medius are best to “prime” the body to use the right leg muscles when actually running.

Exercises such as the clamshell, hip abduction, and fire hydrant are great places to start.  It is essential to perform these with emphasis on the gluteal tissues without activation of your TFL.  This is where access to EMG (electromyography) would help.  Most running specialty physical therapy offices will have this technology to help your initial training.

Muscle EMG
Example Of Muscle EMG Used At Competitive EDGE Physical Therapy In San Jose

After you have proper activation and strength of your gluteal tissues you will need to practice proper running.  Real-time feedback on a treadmill with video is key.  You can also ask a friend to record your treadmill running and use the feedback to work on avoiding things like cross over and inward knee rotation.  

These form changes take time but are invaluable in the long term recovery from IT band syndrome.  You can overcome IT band syndrome without the torture of the foam roller.  Choose form over foam!

By Dr. Kevin Vandi DPT OCS CSCS

Dr. Vandi is the founder of Competitive EDGE Physical Therapy — with his background in physical therapy, orthopedics, and biomechanics, he is a highly educated, compassionate specialist. Using state-of-the-art motion analysis technology and data-driven methodologies, Kevin has assisted a wide range of clients, from post-surgery patients to youth and professional athletes. When he isn’t busy working or reading research, he spends his time with his wife Chrissy and their five wonderful children, often enjoying the outdoors and staying committed to an active lifestyle.

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