Dealing With an IT Band Injury

I've had several people leave comments or email me for advice on how to address an IT Band injury during training, so I thought I'd post this for those folks, most recently Burt, and others who have similar questions.

While I'm definitely not an authority of the medical or athletic sort, I can speak from my experience on what worked well for me, based on the advice of an orthopedist, physical therapist, massage therapist, the DFMC team coach, and lots of friends who have overcome ITB problems.

If you find yourself with an IT Band problem, felt primarily as a pain in knee (as well as a pain in the ass, I'm sure), the best thing to do is to immediately switch from running to cross-training for the time being, until you don't have any knee pain while running. The bike and elliptical machine are great to use, but the best approximation to running without impact is the Arc Trainer or pool jogging, if you have access to either of those options. This is not an injury to try to "run through" as that never works for healing what amounts to tendinitis.

In addition to rest, I took 800 mg of ibuprofen twice a day and iced my knee 3x/day for 20 minute intervals. These will help a lot with the inflammation. The knee pain in large part comes from scar tissue over the knee (and hip) muscles, which builds up from an inflamed and very tight IT band tendon, so you want to minimize the scar tissue by reducing the inflammation. To address this, my orthopedist also advised me to deeply massage the spot on my knee where it hurts with my thumbs for a few minutes several times a day to break up the scar tissue. It can be painful to massage there, but in the end, it was helpful.

Also painful but very helpful is to stretch out that tendon with a foam roller 3x/day for 30-60 seconds per leg. This comes from my physical therapist (and friends). You basically lie on the roller with your quad against it and roll along the tendon to elongate it. Roll all the way from your hip to the outside of your knee (but not across the knee), since the tendon stretches all the way from your hip bone to your knee. The foam roller was what made the most difference for me. There are other stretches you can do, too, but it's a hard area to stretch, and I've found the rolling to be more helpful.

If several weeks of rest don't seem to do the trick, or if you're anxious for professional help because you have a race approaching, you could see an orthopedist for a cortisone shot, but the shot did nothing for me, if I'm to be honest. A doctor could give you prescription anti-inflammatories, as well, if you're desperate for something stronger; these helped me a lot. I asked for pain killers like Vicodin, but the doctor told me that unless I wanted to run the marathon with leprechauns and fairies, I'd be wise to stay away from those kinds of meds.

A massage therapist who knows how to work that IT Band can be very helpful, too, I've found. I had a massage this morning, specifically to loosen up my ITB, and it was tremendously helpful.

So, the best thing is to lay off (I know, it's hard to not run), cross-train to keep your aerobic capacity up, ice, massage with your thumbs, and use the foam roller.

When returning to running, I had to take it gradually and begin with a walk/run technique, building mileage over time. I suffered the worst of my injury last April, ran a 5k pain-free in June, and did a half-marathon in October. If you're training for a marathon that's approaching, and you want to try to run it, I think the best advice I got was to reframe my goals to finishing, as opposed to a specific time. This allows you to gauge how much running you can manage during the race, and how much walking you'll need to do, without the experience being a disappointment. My husband--and others I know--have finished marathons while experiencing ITB trouble.

You'll be back out there before you know it!

Good luck!