Knee IT Band Pain

Member Question

I have this very annoying IT band pain in my left knee only. It comes and goes out of nowhere. Last year I had it and took three months off and now slowly started back up. I was averaging three miles 2-3 times a week and on my last 3.5 mile run it started back up. I run in Vibrams. I took it slow, easing back into them. I was doing so good and then my IT band started up again. I worked on core, hips and glute strengthening during my off time and two times a week currently.

I thought it was due to weak hips but now my hips are very strong. When I try the resistance band I first used with them it’s like a flimsy rubber band and the current one is like a new one. I think my glutes and core are still too weak compared to everything else. But I only know one glute exercise and not very good core ones. Is this my problem now?  My training plan has me running three miles three times a week in about a week. Should I continue that or what? I don't want my mileage to drop.

Answer by Grant Morrison, MD
Member AMSSM

I appreciate your persistence and dedication to keep up your running! Sounds like this pain is becoming quite an aggravating nuisance. Based on the information you provided, an IT band problem sounds like a good guess. It also sounds like you have had some good advice on treatment as well. IT Band syndrome, also described as iliotibial band friction syndrome, is thought to be caused by friction of a long band of tissue that runs from the top of the pelvis at the waist, to just below the knee joint. It's job is to stabilize the outside of the leg. Two muscle at the hip help to control the IT band: the tensor fascia lata in the front and the gluteus medius in the back.

Your approach of trying to strengthen the glute and hip muscles is on the right track. Many runners have weak gluteus medius muscles and strengthening them can help. I would want to be sure that your butt exercises work this muscle. This may require a lot of exercises that require the leg to be moved out to the side of your body against resistance. Think of working not just the butt but the "back pocket" or "wallet" area: lying on your good side, and doing repeated leg lifts, making sure you are feeling the muscle in that area working is key. There are a variety of other good exercises that can be done; you might find that working with a good sports-oriented physical therapist or sports medicine physician can be helpful to make sure you are on the right track.

In my personal opinion, stretching of those muscles may be detrimental; you want those muscles to be stronger and more stable. Stretching them makes them longer and less stable. Why would anyone want to loosen the lug nuts on the wheels of the car before you drive down the road? Admittedly not all experts agree on this area however.
 

Other treatments are worth considering: A return to supportive running shoes that limit the amount of pronation in your stride, so that your knee doesn't turn inward as much when you are running, maintaining a more straight alignment, might be helpful. Someone may need to measure your leg length, as having one leg longer than another can create all sorts of abnormal friction patterns. In the past, we have given cortisone injections at the site of the pain in the outside of the knee, but I have not found this to be very helpful. 
 â€¨However since you have been working on this so diligently without success, other causes must be considered. These include but are not limited to: a tear of your meniscus in the outside of your knee joint, arthritis, or a stress fracture. I hope this is helpful. Preventing this from recurring will be much easier once a cause for your pain is found and effectively treated.

Grant Morrison, MD