How to fix Iliotibial Band Pain (without a foam roller)

Have you ever had pain on the outside of your knee?

Maybe you’ve been told your iliotibial band is tight and you need to foam roll or stretch?

This advice is outdated and, to be honest, not going to do a great amount to help – in fact, it takes around 925kg to modify the ITB by 1%, so you flopping around on a bit of plastic isn't going to do much.

So if you don't foam roll it, what DO you do?!

Let's start from the beginning....

What is the iliotibial band and what does it do?

The iliotibial band (ITB) attaches from the pelvis to the shin bone. It is the lateral thickening of the fascia lata - deep fascia which envelopes the thigh. Fibres from two hip muscle also join the ITB – the tensor fascia latae and the gluteus maximus. The ITB contributes to the stability of the hip and knee as well as storing energy during walking/running to make the gait more efficient.

It used to be believed that the pain on the outside of the knee was caused by the ITB rubbing backwards and forwards over the lateral epicondyle of the femur, causing irritation and inflammation. This was thought to be due to over training as it was often seen after a spike of activity. It was assumed that overtraining caused the ITB to become “tight” and therefore it would need stretching to lengthen it or foam rolling to break down scar tissue and release adhesions.

In fact, research suggests the changing tension in the ITB as the knee bends and straighten creates the perception of the ITB moving back and forth – however, it is securely attached to the femur making this motion impossible!

The most current hypothesis suggests that the pain is due to adipose (fat) tissue becoming compressed underneath the ITB during repetitive actions such as running.

So how do we rehab ITB pain?

The first step is to reduce the aggravating activity to a tolerable level. This can be done by reducing the intensity/frequency and/or the volume. It is important that you do not rest completely!

During this time, you can add another form of cross-training (such as swimming) to help maintain your fitness.

There is also some evidence that supports changing the stride of runners with ITB pain. Increasing your cadence (step rate) by 5-10% will result in a shorter and wider stride which can help decrease the strain on the ITB.

Some research has found that individuals with ITB pain have a weakness in their hip and knee – BUT there has also been conflicting research. Either way, the general consensus is that you can’t go wrong getting stronger, and so resistance exercises are also recommended.

Depending on your pain levels, a simple hip and leg strengthening program may go something like this:

Of course, if you have any doubts about your condition or whether these exercises are suitable, please seek advice from a medical professional before commencing.

Hope you found this information useful! Any questions please let me know below or contact me directly.

References:

Boyer et al. (2015). Rearfoot, mid/forefoot, and barefoot running: biomechanical differences related to injury

Chaudry et al. (2008). Three-dimensional mathematical model for deformation of human fasciae in manual therapy.

Fairclough et al. (2006). The functional anatomy of the iliotibial band during flexion and extension of the knee: implications for understanding iliotibial band syndrome.

Friede et al. (2022). Conservative treatment of iliotibial band syndrome in runners: Are we targeting the right goals?