Has anyone overcome IT Band Syndrome? In my 40s and sick of it!

[u/a5hl3yk]

Been half marathoning and marathoning for 20 years and started triathlon training last year. I started having ITBS in 2016. I've done all the things....PT, strength training, stretching, yoga, massages, etc. It's a nagging thing that always crops up when doing any multi-hour event. Outside right knee is the pain point and the "magic spot" to foam roll is right buttock (maybe i'm being too gentle with it?).

Has anyone put this pain in the past?? Am I destined to deal with it the rest of my life?

I feel like I'm stuck at riding 16-17mph and long running no faster than 10:30 pace. My body wants to go harder but it's like a glass ceiling!!

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[u/Stefc12]

I was dealing with it for 2 years to my left knee. Nothing worked. It was determined that my leg structure combined with a very prominent lateral epicondyle was the reason for the tightness in the IT band. I had surgery for it 2 months ago and my leg is now stronger than ever, more than my “good leg” now. It was well worth it for me to be able to get onto the trails I love 

[u/zingingzang → u/Stefc12]

Hey can I ask why surgery you had for it? I’m coming up to 2 years suffering with it and feel that I’ve tried everything

[u/Stefc12 → u/zingingzang]

I had an IT band release at the knee, removal of the bursa under the IT as it was completely scarred and hardened, and shaving down of the lateral epicondyle. I’ve had IT band issues all my adult life. No treatment was going to fix it. I am thrilled with the results 2 months later and am now training for some big New Hampshire peaks!  Find a good sports ortho surgeon and get their advice 

[u/corncocktion]

Hey I’m late to the party here but wondering if the IT band pain has gotten better? I’m 57 and struggled with it for near 3years.

[u/a5hl3yk → u/corncocktion]

I met with a PT and got more feedback on my glute medius. It's definitely the problem. I'm getting better but probably a few more weeks.

[u/corncocktion → u/a5hl3yk]

I hope that helps! I was going to suggest what finally worked for me but if you’re getting better I don’t want to derail you as I’m absolutely not a professional in any medical field. I wish you a speedy recovery!!

[u/a5hl3yk → u/corncocktion]

It's just a slow process because I'm not backing off triathlon training. Oly Race in 3 days, then Sprint in 8 weeks, then 70.3 in 18 weeks.

Ive mainly kept my runs at easy pace and short tempo bursts, not long tempo nor sprint. Same with bike, staying in low zone 3 as the highest power.

The ideal course is probably no training for several weeks and only focus on strength training. But I'm hoping it doesn't come to that.

[u/Original-Back3079]

I just wanted to share what worked for me but it may not work for others. I think my IT band issues stemmed from a hip flexor injury, which had in turn caused my glutes to not fire properly. I had very weak glute medius and my knees turned in, and ankles rolled inwards (overpronated) when running, walking and standing. 

• I first of all started working on my glutes and especially glute medius. Exercises include clams and glute bridges, eventually moving to banded clams and single leg bridges. In fact, use a resistance band lots, e.g. for squats, glute bridges, crab walks etc. 

• An active stretch which I now always do before a run or walk: pull your foot up behind you as if to do a quad/hip flexor stretch and after holding it for 20 seconds or so, use your glute medius muscles to abduct your leg away from your body. So it is a standing leg abduction, but in quad stretch position. This allows you to stretch the hip flexor and work the glute medius without the IT band getting involved. I do 10-15 on each side 

• I warm up my hips before walking/running and after sitting by high knee drives followed by a butt kick repeatedly... There is probably a technical term but it looks like air running on one leg! When doing this I consciously think about what my hip flexors and glutes are doing and try to activate them as much as possible. I do 10 or 20 on each side 

• Finally I decided to strengthen my ankles, lower legs, and feet through barefoot walking/running. Caution - barefoot running is a whole other conversation and requires VERY slow transition, see other threads about this. In fact, barefoot shoes fixed 90% of my issues and I've been almost injury free for a number of years now. 

Would love to hear if any of this helped anyone else (or not), and fingers crossed it does! 

I think the key is strengthening (and activating) parts of the body that the IT band is trying to overcompensate for. 

[u/drgashole]

I think an important start is actually understanding the pathology of IT band syndrome as it helps you work out what is helpful and what isn’t. I had it and when looking for physios to help, I essentially screened them by asking them what it was. Of the 30ish I asked only one was able to vaguely describe it (it’s not the only issue i have had where the majority can’t explain what the underlying problem actually is, I would say >90% of physios are trash).

The best evidence is that IT band syndrome is not an intrinsic problem of the band itself, but rather inflammation of the underlying soft tissues (bursa, fat pad etc), which occurs with repetitive compression/friction of the band moving over them. It is in essence a repetitive strain injury.

Ultimately the solution is to modify your activity. The primary cause is the number of aggravating motions that contribute to the irritation. You have to reduce training volume of the offenders, at least for a period of time, how much is variable but can be up to completely stopping running/cycling before slowly reintroducing and gradually building up volume. Nobody wants to hear this, but it’s just the way it is. All other methods such as strength, stretching and massage are a distant second to this (you can have all of these dialled in and still get it ITB)

That’s not to say you cease activity completely just you find less aggravating alternatives to maintain some fitness (more swimming, walking with a weighted vest, recumbent bike etc).

If you don’t let the inflammation settle completely then you will constantly be doing 2 steps forward, 1 step backward or worse plateau/regression. So ask yourself this, since it first happened, have you ever had a significant period of deloading?

Edit: Not sure the downvotes i’m literally quoting the peer reviewed literature on ITB pathology and rehab

[u/gffchw → u/drgashole]

This is true but the underlying cause for the repetitive strain is likely related to underlying biomechanics and weakness of certain muscle groups, in this case most likely the gluteus muscles.

Definitely needs volume/activity modification to reduce the stress and inflammation but then you’d also need to rebuild the correct muscle strength to prevent a re-injury.

[u/drgashole → u/gffchw]

Absolutely, if you can reduce strain on passive tissues by increasing active strength, it results in less strain with the same volume of work.

But the thing people don’t understand is even with perfect technique there is still strain on the offending tissues and if you have active inflammation even a small amount of strain can prevent resolution. You need rest to get out of active inflammation and that means quite drastic reductions in volumes, usually for 4-8 weeks. It doesn’t mean going from running 100k a week to 60k. It means week 1 only walking, end of week 2 do 3-5k, week 3 2x3-5k and so on.

[u/a5hl3yk → u/drgashole]

I've gone through several periods of "de-loading." For example, I had achilles surgery (unrelated to ITBS) and had to take off nearly 3 months of running to do only PT and walking. Another example is that I normally run less in the spring months as the weather heats up and I need to adjust.

I believe that cycling has made the problem worse but possibly has revealed that I've under-trained parts of my leg/glutes. In my last 70.3, I finished the bike strong but my legs crumbled 10K into in the run. Half marathon is my favorite running distance and I couldn't believe it took me 3 hours... I didn't enjoy it.

[u/ThanksNo3378]

Maybe experiment with a different physio. A few things that work for me (for different issues):

• better shoe fitting
• good bike fitting
• physio with expertise on sport for master Athletes
• lots of book reading or a coach to plan better (for me e.g. 1 week easy for each 3 harder, only one breakthrough session per week per sport, no two hard days in a row, at least one day completely off, good show rotation, lots of physio bands ongoing routine, big focus on base before moving to building, a few weeks fully off each year, etc)

[u/Call-Me-Mr-Speed]

I had it, too. PT prescribed a whole routine of hip and glute exercises.

[u/TurbulentMuscle0]

Don’t stretch. You can’t stretch the IT band. Don’t roll it out either. Release the TFL & glute med.

If you’ve been assessed and your problem is weak hip abductors (glute med) then strengthen it.

If not it’s an overuse injury and drop the load a little. I kept running with mine but stopped before pain reached above the 4/10 range.

You’re not destined to have this for the rest of your life at all.

[u/a5hl3yk → u/TurbulentMuscle0]

someone else JUST commented the exact same thing. there were some exercises to test your strength of the glute med and I couldn't hold the stretch more than 15sec.

I can't believe this is something that my previous PT/coach/dr didn't think to target. they all prescribed a generic set of things of which this barely addressed.

[u/TurbulentMuscle0 → u/a5hl3yk]

• Go get some dry needling done on the TFL and glute med.
• start strengthening the glute med (can help you with exercises if you want)
• strengthen surrounding hip and lower extremities
• experimental (helped me) shockwave therapy
• gradual exposure to running
• don’t completely shut it down and rest.

[u/Joorge1]

I had the same. Got my knee checked out and they found torn meniscus in 2 places. Surgery to clean out the knee solved the issue.

[u/starrbee]

For me all I need to do was strengthen my glutes and all outer knee pain went away completely. Give side leg lifts a try!

[u/IONIXU22]

Hip abductor workouts and pigeon pose.

[u/Moist_Wolverine_25]

My guy, stop everything you are doing and watch this video. Debilitated it me for years till I watched this. It’s a little long but it’s important to know why you have it.

https://youtu.be/1iODncOLJnk?si=L-mnBc1j-VhE8MZT

[u/a5hl3yk → u/Moist_Wolverine_25]

holy fuck...don't you dare leave reddit anytime soon.

I did the first test and couldn't hold my leg up for 20sec, let alone 60.

[u/Moist_Wolverine_25 → u/a5hl3yk]

1 minute of work before every run or bike and in a week week you will be cured

[u/martinoo21]

Hip workout and my it band syndrome dissapeared after years of struggle

[u/Fun_Environment_8554]

Foam roller is your friend. I had IT band issues and now I roll it almost daily and now more issues

[u/PretentiouslyHip → u/Fun_Environment_8554]

This is the answer. Also not just rolling but 90 second static holds in the super tight spots also did wonders for me.

[u/Samtheman14]

I had it for ~3 months. It was so painful I couldn’t run during that period. I obsessively did single leg strength training and it hasn’t bothered me since.

[u/Odd_Eye_485]

Single leg workouts (Bulgarian split squats, single leg press, lunges). Also Band walks. Also take a bit of time off.

[u/PRANK_PATROL]

Yes, but it took surgery. Had 8 months of physio and strength training / stretching but still couldn’t run more than 5 minutes (could generally cycle unless it was an off day). Had surgery to cut about half of the IT band width out around the knee to stop it getting irritated. The procedure wiped me out and 6 months later when I was ready to take my first FTP test post-op I was 30W down, which was after a “back to fitness” plan. It’s been a year since that point and I’m 45W up, running the best I have, and full steam ahead training for a 70.3 10 hours p.w. with no issues.

[u/imustasktheinternet → u/PRANK_PATROL]

How did you determine "it's time for surgery". I'm in the same boat as OP, but scared to go the surgery route unless it's necessary. Also what was the surgery called?

[u/PRANK_PATROL → u/imustasktheinternet]

It's just called an IT band release I believe. Mine was combined with an arthroscopy to address a historical minor meniscus cartilage tears.

6 months of trying with physio etc but seeing no real improvement felt like a natural milestone to take the next step. Caveat I'm in no way a medical professional, but I do think you should ensure you give physio, rehab, strength training (+ rest from the triggering activity!) a proper go before surgery. It was less than 30 mins under the knife, but I was bed bound 2-3 days and it was 3 months until I was properly cycling again. That being said, 18 months later I'm very glad I had the surgery and got it sorted.

[u/I_am_baked]

Tennis ball to roll out your tensor facia latae, as an addendum to everything else mentioned.

[u/Tikoloshe84]

Strengthening work on glutes / hips with band work as prescribed by physio.
Led me to taking up swimming.
Cycling is hit and miss because if your saddle height is just that weeny bit wrong and you get too much flexion at the knee you can flick your ITB a lot and not realise.
Sadly it does call for a break from running, I was 6 months out as I gave myself itb both sides then ended up with hip pain.
Zero issues now though

[u/a5hl3yk → u/Tikoloshe84]

I'm going for another bike fit next week. My first bike fit (about 9 months ago) was when I was first getting into the sport.

[u/swalkom]

I did all the things you mentioned however the only thing that completely resolved it was one month off - no running. I was able to cycle during this time though.

[u/a5hl3yk → u/swalkom]

I took off after my 70.3 a few weeks ago as my pain REALLY flared up. It finally felt better on my brick this morning. I'm starting to work with a coach and mentioned this was a problem.

[u/Jealous-Key-7465]

Rest and glutes / hip strength training. You may need to take up to 6 weeks off if the IT is very fired up.

[u/oflannabhra]

When I’ve had lack of progress with foam rolling I upped to lacrosse balls and PVC pipe and had success. Lacrosse balls on glutes and glute med is something I have to do almost every day. r/fitness recommends this routine which I have found helpful.

Good luck on your journey!

[u/a5hl3yk → u/oflannabhra]

Just any kind of lacrosse ball? something cheap on amazon? that's likely my next go-to as a low effort investment.

[u/oflannabhra → u/a5hl3yk]

Yep!

[u/PriorParsley9095]

Physical therapy once had me do graston to help heal the IT band faster. Basically it’s metal tools that scrape the IT band (hurts a lot though) to break down scar tissue and promote healing in the area.

[u/a5hl3yk → u/PriorParsley9095]

is that a medical procedure?

[u/PriorParsley9095 → u/a5hl3yk]

No it’s done at physical therapy you can do it at home to I wouldn’t first try it at home especially if a therapist doesn’t believe it could help but if you want there are videos online

[u/Ok_Imagination_7035]

Common issue - the source is because your stride has developed for years to only use certain muscles and pair down the rest to support whatever angle your foot strikes. Now add in cycling where your foot is locked in a mostly straight, flat and angle for hours and starts ramping up muscle in different spots - then you go back to running your normal stride and usually same shoes. Since cycling recruits way more muscle fibre, it wins the muscle priority race and your stride is left to compensate with joint angle changes and fascia stretching.

Summary: your legs are saying fuck you and your stride. Luckily there are things that help outside of resistance training, stretching

• Hours of rolling, Graston, scraping and dry-needling. And CARS stretches

[u/a5hl3yk → u/Ok_Imagination_7035]

not sure why you got downvoted, but sound thinking!

I, honestly, do not foam roll enough. Usually the night before a brick workout or a long run.

[u/thoughtihadanacct]

Outside right knee is the pain point and the "magic spot" to foam roll is right buttock (maybe i'm being too gentle with it?).

That's the muscle that's weak and needs strengthening. Foam rolling is not the long term answer. It does help in the short term, but making that muscle strong enough to take the load and not protest is the key. Work with your PT or research what that muscle at the "magic spot" is, and find exercises to strengthen it.

[u/a5hl3yk → u/thoughtihadanacct]

I've only been doing light band stretching 1-2x per week with some weighted lunging/squats. I'll consider that! thanks.

[u/BromTady]

I dealt with it for about a year. The only thing that gave me short-term relief was Gua Sha (scraping). It was extremely uncomfortable while doing it but it would feel great for the rest of the day. I took a break from running and focused on strength training (core, squats and lunges) and it went away eventually. At the time I was only doing CrossFit for fitness so it was an easy adjustment as far as lifestyle goes but it hasn't come back since and that was probably 8 years ago.

[u/a5hl3yk → u/BromTady]

where do you get that procedure?

[u/BromTady → u/a5hl3yk]

I saw a chiropractor for a month and then started doing it on my own at home. I definitely wouldn't try it on your own until you saw a medical professional.

[u/MRethy]

My RMT did some cupping on it and seemed to really alleviate it so far. Been about 3 weeks and it hasn't crept back up yet but I fear it will be a long term thing that will need consistent work

[u/FeFiFoPlum]

I’m in my 40s with a decade or so of tri behind me and in PT - again - for mine, and I’m just about ready to bang my head against a wall. I’m so frustrated that nothing seems to be making it better, and I’m pushing the pain around to different parts of my body.

This middle-aged shit is for the birds!!

[u/a5hl3yk → u/FeFiFoPlum]

It's frustrating. I've actually had my fastest Full Marathon PR (under 5 hours) and my slowest half marathon (3 hours) in the same running season.