Do you have knee pain when you run? You’re not alone. Knee injuries are the most common
ailments plaguing runners, and triathletes are no exception. There are many causes of knee
pain but I’d like to focus on one: IT band syndrome.

First, what is the IT band? “IT” stands for iliotibial band—a thick fibrous band that runs from the hip bone, travels down the side of the leg, and finally connects just underneath the outside of your knee. Because this band connects to aspects of both the hip and the knee it has a crucial role is stabilizing both structures.

Second, what is a syndrome? As defined by Webster, a syndrome is “a group of signs and symptoms that occur together and characterize a particular abnormality or condition.” So with IT band syndrome there may be multiple issues relating to pain. In order to truly fix the problem you’ll want to identify all causes and fix them.

Those who have experienced IT band syndrome know that this fibrous tissue can cause a lot of pain around the outside of the knee. Traditionally it’s been thought that this pain occurs due to friction generated when the band crosses over the side of the knee as it bends. Since every stride you take running involves bending and straightening of the knee, it’s obvious to see how this could become painful. More recent research suggests that a layer of fat around that part of the knee is actually the source of the pain, not necessarily the friction caused by the rubbing. Regardless, it doesn’t really matter for the injured athlete because it still hurts.

Although the pain associated with IT band syndrome is at the knee, the cause of the pain may
be somewhere entirely different. (Remember how a syndrome is a group of signs and
symptoms.) Some common causes of IT band issues come from:
• increasing mileage too quickly (more demand on that tissue than the body can
accommodate)
• hip muscle weakness (remember how the IT band attaches to the hip)
• tight muscles or fascia (the IT band directly touches a lot of different muscles)
• poor biomechanics due to weakness or neurologic deficits (sometimes the strength is
present but just not utilized leading to pain)

So how do you know which of these issues (or more likely which combination) is impacting your performance? The thorough way to address the question is to consult your local physical therapist. Through testing strength, measuring flexibility, analyzing mechanics, discussing
training volume and injury history a skilled therapist will identify the issues and help you create a plan to get you back to training and racing.

However, the most common and certainly the easiest answer comes by googling it. Although Dr. Google can be a huge help, the advice you read will rarely be individualized so you should interpret results with a grain of salt. Here are some things to consider when you consult the interwebs:

• The IT band is comprised of fibrous tissue—it’s not really made to be stretched. Think of a plastic bag; if you stretch it, the form is lost and the bag won’t perform its purpose. The same goes for the IT band. We want rigidity because it allows for stability through the knee and hip. However, too much rigidity leads to pain.
• With that in mind, when you’re “foam rolling the IT band” I’d argue you’re not “stretching” the band so much as you are mobilizing the tissue that connects and/or interacts with the band. So going after the quads, hamstrings, and glutes can still help decrease the tension along the IT band.
• If you take a closer look at the IT band, there’s a portion of it which connects to the tensor fascia lata (TFL). If your pocket was a muscle, it would be the TFL. Some people get a lot more relief by rolling out the TFL directly than focusing on the IT band.

Lastly, there are lots of quick fixes on the internet on how to cure just about everything but finding the true source of the problem and addressing it will keep you pain-free much longer. While you may try different quick fixes, it’s best to listen to your body, have a trusted physical therapist check you, and make sure there’s not something deeper than just some nagging IT
band pain going on.