What is the ITB and what causes ITB pain?
The ITB, or iliotibial band, is a thick piece of connective tissue on the outside of the leg, extending from the outside of the pelvis, over the hip and knee, inserting just below the knee. “It helps stabilise the knee and hip during running,” says physio Mark Richardson from Perfect Balance Clinic.
“Pain usually presents at the side of the knee, coming on about five minutes into a run and worsening as you go. It may disappear when you stop. Pain in this area is often associated with the ITB, but generally the cause is related to other issues. Usually it’s due to tight muscles around the hips, including the glutes (buttocks) and quadriceps (front thighs). Or, if you’re lacking stability around the pelvis and core, this can cause a greater force to be exerted onto the ITB, resulting in pain and the perception of it being ‘tight’. Generally, the ITB doesn’t get tight and stretching your ITB is practically impossible.”
How do I treat it?
Improving stability around the pelvis may help to alleviate the problem. “A physio can analyse your gait to see if the pelvis is dropping upon foot strike,” says Richardson. “You want to build up strength around the hip stabilising muscles and the core. This helps the pelvis maintain balance when you are running and loading through the lower limb, reducing the compression on the ITB.” Richardson recommends hip and glute exercises (try these exercises), alongside side planks to improve strength.
The gradient you run on can also cause pain. “Running downhill increases the stress around the ITB, because of the knee flexion angle at foot-strike,” says Richardson. “The average knee flexion angle is around 21 degrees on foot-strike running downhill. Anything below 30 degrees flexion may cause pain around the outside of the knee. Running on flat surfaces and running at a greater speed seems to be more comfortable because knee flexion is beyond 30 degrees.