IT Band Pain in Runners: Expert Guide to Recovery and Prevention
IT band pain in runners is one of the most common and frustrating injuries that can sideline your training. That’s why I’m excited to share insights from my wife Dr. Maria Leibler. Maria is a physical therapist and running rehab specialist who has committed her career to treating runners with all types of injuries.
I’m Jason Leibler, Maria’s husband, and today we’re continuing our series of posts where I interview Maria to learn more about common running injuries. Today we’re tackling IT band pain—something that affects countless runners each year.
If you’ve ever experienced that sharp, stabbing pain on the outside of your knee during a run, you might be dealing with IT band pain. In this interview, Maria breaks down what’s really happening, why traditional approaches often fail, and how to actually fix this frustrating issue.
Where Does IT Band Pain Occur?
Before diving into Maria’s expertise, let’s clarify what we’re talking about. The IT band (iliotibial band) is a thick, fibrous band of connective tissue that runs along the outside of your leg, extending from your hip (pelvis) down to just below your knee.
When runners experience IT band pain, it typically presents as a sharp, burning sensation on the outside of the knee. Some runners describe it as a stabbing pain that appears a few miles into their run. Others might feel discomfort that extends up the outer thigh. The pain often worsens with continued running, especially during downhill sections, and might even force you to cut your run short.
What Does The IT Band Do?
The IT band (iliotibial band) is a thick band of fascia that runs along the outside of your leg from your hip to your knee. As Maria explains:
“The IT band is a structure that provides stability to your knee. Running is considered a high-impact sport—essentially hopping from one leg to another for a long period of time. The IT band will take on increased demand when other structures or regions of the body aren’t capable of providing enough stability for themselves.”
In other words, when you run, your IT band helps stabilize your knee. But when other muscles aren’t doing their job properly, the IT band takes on too much stress, leading to pain.
Why Does My IT Band Hurt When I Run?
According to Maria, IT band pain typically develops because of capacity issues:
“Typically runners don’t have enough capacity, whether that be strength or endurance, for the demand of whatever task they’re doing repetitively, usually over weeks or months.”
Muscle Weaknesses That Contribute
When I asked Maria about specific muscle weaknesses that contribute to IT band pain, she identified two main culprits:
- Weak Quadriceps: “I often find the quadriceps don’t do a good enough job at absorbing enough force.”
- Weak Glutes: “If somebody’s lateral glutes truly are weak and they don’t have the neuromuscular control to prevent excessive pelvic drop, that can put more stretch on the IT band as it accepts load. The lateral glutes—gluteus medius and minimus—are particularly important.”
Jason’s translation: Basically, the muscles on the outside of your hip (your lateral glutes) help keep your pelvis level when you’re running. If these muscles are weak, your pelvis can drop to one side when you’re on one leg, which stretches and stresses your IT band. Think of these muscles as the support system that keeps everything aligned when you run. When they’re weak, other structures like your IT band have to pick up the slack.
Running Form and IT Band Pain
Does your running form matter when it comes to IT band pain? Maria says yes:
“Running form can play a role, especially for runners who overstride. When overstriding, your foot lands further out from your body, resulting in your knee being more extended or straighter than what’s ideal for the muscles—specifically the quads—to absorb force. This puts more load through stabilizing structures like the IT band.
If you prevent overstriding, say by increasing your steps per minute (cadence), you’ll shorten your step length. Your knee will be slightly more flexed when you hit the ground, allowing your muscles to absorb that energy better, creating a more even distribution of force through different structures.”
The Truth About Foam Rolling and Stretching
Here’s where Maria challenges conventional wisdom. When asked about foam rolling the IT band, she explains:
“Foam rolling can help with symptom modification, but it’s not something I recommend for most runners, especially if they’re strapped for time and want the best bang-for-their-buck interventions. They’re better off addressing the underlying issues, such as the strength component, overstriding, or looking at their training load.”
And on stretching the IT band, Maria didn’t mince words:
“The biggest myth about IT band pain is that you need to stretch the IT band. You can’t stretch the IT band—it’s extremely tough tissue designed to resist load. It’s fascia, and you can’t stretch fascia, nor would you want to. You want it to be stable and strong.”
Can You Keep Running With IT Band Pain?
Good news for runners dealing with IT band pain—you probably don’t need to stop running completely:
“Most runners can continue to run with some modification to their training,” Maria says.
However, she cautions that if you’re limping or changing your running form due to pain, that’s a sign it’s time to seek professional help.
How to Prevent IT Band Pain Recurrence
If you’ve had IT band pain before, Maria confirms you’re more likely to experience it again. To prevent recurrence, she recommends:
- “Making sure your training plan is appropriate and you’re not having major spikes in your running volume.”
- “Maintaining a good strength program.”
- “Preventing overstriding.”
Essential Strength Training for Runners
When asked about specific exercises for IT band health, Maria emphasizes a comprehensive approach:
“I generally make sure every runner is targeting all four major muscle groups of the legs: the calves, the quads, the hamstrings, and the glutes.”
Best Exercises For IT Band Pain
To Address Quad Weakness:
Since quad weakness is frequently associated with IT band pain, here are some effective exercises to strengthen them:
Progressive Step-Downs – Stand on a step, slowly lower one foot toward the ground with control, lightly tap the floor, then push through the standing leg to return to the starting position.
Bulgarian Split Squat – Stand a few feet in front of a bench, place one foot behind you on the bench, lower into a lunge by bending your front knee while keeping your chest upright, then push through your front foot to return to standing.
Weighted Squat – Hold a weight at your chest (or on your back), stand with feet hip-to-shoulder width apart, lower your hips back and down while keeping your chest upright, then push through your heels to return to standing.
To Address Lateral Glute Weakness:
For lateral glute strengthening, these exercises can be particularly helpful:
Monster Walks – Place a resistance band around your ankles or above your knees, take small, controlled steps forward and backward while maintaining tension in the band and keeping your knees slightly bent.
Side Planks (With Leg Lift if Possible) – Lie on your side, prop yourself up on your forearm with your body in a straight line, engage your core, and lift your top leg while keeping it straight—hold for time or perform slow reps.
The key with these exercises isn’t just doing them occasionally, but incorporating them consistently into a progressive strength program that gradually increases in difficulty as your muscles adapt.
Terrain Considerations
Certain running environments can aggravate IT band pain:
“Generally, running downhill is worse for individuals suffering from this type of pain. Uphill may be a little better,” Maria notes.
When to Seek Professional Help
While IT band pain can sometimes be self-treated, Maria suggests seeing a professional if:
- “Your pain is increasing or worsening despite what you do.”
- “You are unable to resume running due to how intense the pain is.”
- “You don’t have any idea of how to improve it or don’t have any clues on how to modify your running.”
How To Fix IT Band Pain In Runners
As a professional running rehab specialist, Maria’s process for treating IT band pain is systematic:
“When I treat IT band pain in runners, my first step is to identify any areas in their training that may be overloading their system and affecting recovery. This could be things like sudden mileage increases, intensity changes, the terrain they’re running on, or not allowing enough recovery time.
From there, I make small tweaks to their training to reduce strain—this might mean adjusting their route, terrain, or intensity so they can keep running without making things worse. I also look at their running form to see if they’re overstriding, which can put extra stress on the IT band.
If they don’t already have a strength program, I introduce key exercises to build up the muscles that support the knee and hip. If they do, I fine-tune it to make sure it’s actually helping.
When they start feeling more confident and in control of their pain, I guide them through a structured return to normal training, making sure we change only one thing at a time—whether it’s mileage, speed, or terrain—to ensure their body tolerates it. The goal is to not just get them back to running, but to make sure they stay pain-free long-term.”
What Happens If Left Untreated?
Ignoring IT band pain can lead to more serious issues:
“More than likely your body will begin to compensate. You may start limping, and problems can start moving around the kinetic chain as your body tries to escape the pain. This causes you to run differently, which is never what you want because you’re just shifting the load to a different structure that’s not equipped for that amount of stress.”
Final Thoughts
The bottom line on IT band pain, according to Maria: “IT band pain is totally treatable as long as you ignore lots of bad advice circulating out there. The key is strengthening the right muscles, avoiding overstriding, and following a smart training plan that doesn’t overload your system.”
If you’re dealing with persistent IT band pain and want expert guidance, get started with a discounted first visit. We’ll help you identify the root causes and develop a personalized plan to get you back to pain-free running.
