Navigating IT Band Pain Syndrome

Navigating IT Band Pain Syndrome


The reason iliotibial pain is a worthwhile topic to investigate is on one level quite painfully obvious; pain is not fun and those of us in our right minds want it gone. Beyond the immediacy of not enjoying pain though – there are much deeper and broader reasons to learn about and resolve your ITB pain. We will take a deep dive into this and into the relevant solutions here.

Stubborn pains are nearly always signs of ‘wear and tear’ occurring in the body, that we ignore at our peril. The pains in your leg are no less of a call to action than the pain you get when you touch a hot stove. You aren’t supposed to ignore the hot stove pain because you can get burnt: and you aren’t supposed to ignore the IT band pain because you could develop wear and tear or at least significant scar tissue in your leg.

Most of the stubborn ITB pain syndromes we treat people for at our clinic are functioning as an alarm bell for broader microscopic ‘wear and tear’ that has begun to accrue in the patients lower body – and not only in the thigh and hip, but also the ankle knee and hip too.

If your IT band is under strain your whole leg is under strain. If you have IT band pain and have also noticed other pains like knee pain, back pain, foot pain or hip pain (on either side) they probably relate to the same underlying weaknesses/imbalances that cause your foot pain. If you only have iliotibial pain that’s good – but there may be stress playing out ‘quietly’ in other areas that will need attention later.

From my perspective – after 20 years in the front line of pain management the big reason to get on top of ITB pain syndrome is in reality freedom. Our entire lives are based on the ability to move, even for the most sedentary of us the ability to get around is a cornerstone of health, happiness and freedom.

I meet a huge number of young people (under 70) who are suffering desperately from a loss of the freedom to move comfortably, and I see both their health and happiness suffer as a result. Freedom to move –  freedom to stay active and healthy – and the freedom to have a choice in what we do with our lives; that’s what is at stake when we are learning about and managing pain. And no offence intended – but many of you have a bit still to learn in this area.

Up until the 16th Century people had no idea that there was such a thing as bacteria and they had no idea what caused tooth decay. Believe it or not, most people thought that the holes in their teeth were caused by a  little nocturnal worm that burrowed into your tooth.

It seems amusing to us. But if you think about it the boara holes in wood are caused by little worms, so there was definitely logic in the theory. If you don’t know that microbial life even exists (they didn’t) how could you hope to understand the underlying process behind tooth decay.

There is a good reason for the brief history lesson. Many of us these days are almost as unsure of the real causes of our iliotibial band pain, foot pain, back pain, hip pain, ankle pain and knee pain; as folks were about the causes of tooth decay back then. And not only do many not know what the cause is, most seem quite unsure as to what the steps they should take to resolve their ITB pain etc.

The lack of understanding wouldn’t matter so much, except generally our understanding of such things tends to dictate how successfully we self manage, and also how skilfully we select the right professional help.


For most iliotibial pain syndrome sufferers a very straight forward 3 step process is the best template for resolving their pain.

STEP 1 – Diagnosis and Education. Identify and understand the pain, and the cause of pain.

STEP 2 – Pain Management. Deal with inflammation and scar tissue in painful area. Relieving but also in preparation for proper rehab.

STEP 3 – Rehabilitation. Usually some combination of gentle daily strength exercises, some stretching  and custom insoles prescription. 


The truth is that all stubborn pains including IT band pain are complex. There is no single root cause in a stubborn case of back pain ITB pain or plantar fasciitis. Stubborn pains are more like jigsaws. The good news though is that there are usually a few key pieces of the jigsaw which fit together to make life  becomes a whole lot easier.

Let’s take a generalised look at some of the jigsaw pieces that underpin most persistent cases of IT band pain.


The shape of the bones in your ankle was decided long before you took your first breath. The shape of these bones determines how and where you bear weight in your foot. In addition your ankle bones determine how you stand and walk but also how high your arches are and the amount of work your hip muscles need to do to keep you in alignment.

The shape of your ankle bones is a key factor in generating IT band pain syndromes’ because they influence where ‘repetitive stress and strain will tend to occur in the connective tissue of your leg Without going into unnecessary technical detail – those of us with slightly more extreme bone shapes tend to get more pain over a lifetime.

When we are helping people with ITB syndromes we use a wide range of tests and investigations to determine the shape of their ankle and foot bones. Understanding the shape of the ‘ankle bone architecture’ helps make prescriptions that take stress off your feet…but also your IT band.


The truth is that concrete, paving & tarmac are as much of a factor in instances of IT band pain as lollies/soft drinks/cake are in instances of tooth decay.

The density of concrete in particular is extremely unnatural for our bodies, compared to natural surfaces like sand, dirt and paddock. The hardness of urban surfaces like concrete creates a lot of compression and irritation in the connective tissues of our lower body – even through our shoes.

The extreme flatness of urban surfaces is also a big issue for our bodies. The muscles in our feet, knee and hips were designed for the hard daily workout that comes with living on uneven outdoor terrains; when they are only exposed to flat surfaces muscles gradually waste away over time. Muscle wasting in the hip, leg and foot is a major factor in determining who will get IT band pain and who won’t.


Your lifestyle to a large degree determines the physical condition of your iliotibial band, knee and hip – and all the other parts of you for that matter.  The relationship between your lifestyle and your IT band is that familiar old story of balance.

If you play 7 hard games of basketball a week and run 10k every sunday on pavements you massively increase your exposure to stress and strain in your iliotibial band and all the structures it depends upon.

If you sit at a desk all day and lie on a couch all evening; and you just don’t have the time, interest or energy for ‘working out’ you become severely weakened through the lower limb. If we don’t mover ur bodies turn to jelly – andmuscle weakness massively  increases the likelihood of ITB pain.

None of the above is meant necessarily to judge how much or little or little activity you should choose as an individual – your own conscience can be the judge of that. I am just letting you know that if you are live life at the extremes you may be contributing to your IT band pain.

The happy news is that a significant number of the people I have helped resolve their iliotibial pain syndromes over the years were at the extreme ends of the activity spectrum and yet it still hasn’t stopped us getting them relatively straightened out in most instances.


Perhaps surprisingly or unsurprisingly (depending on your level of experience with such matters) stress has been a factor in many of the worst foot pain cases we have helped people with over the years.  We aren’t going to delve too deep here though because we don’t need to. But I am going to tidy this issue up for you in case you need to hear it.

We are physically and mentallY only designed for short periods of stress – not long periods of stress. Long periods of stress effects our bodies!!!

When we are stressed for sustained periods, those of us in vigorous health get few symptoms; but those of us with a weakness or imbalance somewhere in our body will often develop some symptoms in that area due to the effects of the stress. Those with gut problems get tummy pain, the ones with skin problems get outbreaks, those with a weak core get back pain and those with weaknesses in their leg and foot get… you guessed, it well done.

Once again though the news is good! We have treated many people over the years with IT band pain that was triggered by stress. Happily though we can usually still get a good outcome – if the patient is able to take their attention off the stress long enough to do what is necessary to heal.

Often when managing a patient with stress related iliotibial band pain we provide simple coaching on good ways of starting to incrementally reduce stress – which often helps reduce the pain   The truth is though there are no magic bullets for stress – and managing stress is one of life’s big challenges.

The maintenance thrust of our intentions is basically to help people with their physical issues. In a way that makes them more like all the millions of people who don’t get leg pain when they are stressed; this is usually a very achievable goal.


If you have plantar fasciitis or heel pain you will most likely show up looking like any other case needing treatment for IT band pain. Under the surface though you will have a pattern of inflammation, scar tissue build-up and muscle weaknesses that are unique to you!

Treatments for plantar fasciitis that increase blood flow to the plantar fascia.

Treatments that increase blood flow to the IT band can be very useful for promotion of healing and reducing inflammation. Hot and cold therapy, massage, foot rolling and acupuncture are just a few of the ways we can attempt to increase blood flow to the iliotibial band and find some relief. For better outcomes though it is often necessary to so work that attempts  to create deeper changes within the soft tissues.

Treatments for IT band pain that break up scar tissue in the foot.

Most IT band syndrome sufferers ultimately find that it is the breaking up of scar tissue and adhesions in the IT band and its associated muscle groups that brings the most releif.

Scar like adhesions create tightness and mechanical difficulty for the IT band and it will tend to generate pain signals for as long as they stick around. People who foam roll endlessly are repeatedly loosening off this type of adhesion, but rarely getting into it deep enough to get lasting relief.

Graston technique, deep tissue massage, myofascial release and extracorporeal shockwave therapy are all excellent ways of breaking up scar tissue and adhesions in the IT band and its associates muscles.

Treatments for plantar fasciitis that reduce pain signals.

Pills are great, we love them, painkillers are the 8th wonder of the world when you really need them. We should pay respect to the clever people who develop them so that we can get ourselves out of tight spots.

But let’s be honest – pain killers don’t break up scar tissue; pain killers don’t strengthen your glute muscles and prevent your arch dropping – and they certainly don’t reduce the strain of concrete on the soft tissues of your leg.

Ultimately the value of any IT band syndrome treatment is determined 100% by whether it works for YOU – both in the long and short term. That said there are some general rules to be aware of when choosing treatment options for ITB syndrome.

By far the most reliable treatments for plantar fasciitis are those that break up scar tissue and increase blood flow in soft tissues. The forms of IT band treatment that target scar tissue and blood flow make the biggest difference to the greatest number of people in the shortest amount of time. And we are not the only practitioners who have come to this conclusion I can assure you!

Understanding that there are a group of IT Band Pain treatments out there that generally work better than others; and that they all have the same broad intention, is a good way to understand the relative usefulness of the ITB pain treatments on offer.


Once your ITB band pain syndrome has settled down and you are able to have fun again without paying the price of ITB pain its time to make a very big and important decision.

Do you carry on as you were, or do you try to fix the underlying problem. Fixing the underlying problem is called rehabilitation – the idea behind rehabilitation is that it prevents your IT Band pain from coming back in the longer term.

It usually takes a bit of discipline to persist with fixing your ITB pain syndrome in the longer term – and it’s nowhere near as easy to get up for your exercises when you are back to feeling invincible. But… any effort that we’re willing to put into conquering the more and lazy short sighted aspects of our personality is likely to be well worth it in the longer term.

If you want to effectively rehabilitate your IT Band Syndrome in the longer term there are 3 types of activities that you may need to look at – each of them tend to specific parts of the underlying biomechanical issues that caused your ITB issues in the first place.

Stretching & Foam Rolling 

Stretching and foam rolling form the mainstay of most peoples ITB self management and the mainstay of the prescriptions made by countless PT’s and pain practitioners. This is for good reason – the tightening to the iliotibial band is a major component in ITB pain syndromes and releasing that tension can bring a great deal of relief. Restoring flexibility to the IT band is also extremely beneficial fo0r the biomechanics of the knee, hip and ankle – because the ITB helps with the tracking of these joints and the distribution of force during periods of activity.

While stretching is an excellent tool that can be used within a broad strategy for rehabilitating ITB syndromes it should not be relied upon solely. Tighteness and stiffness in muscle and connective tissue are ‘reactive’ phenomena – they happen as a reaction to underlying strain on the body. The higher level activities required to effectively rehab IT bands is the stuff that reduces the strain in the longer term – thereby preventing the IT band from tightening up endlessly in the first place.


The IT band is to a large extent involved with helping transmit muscle forces onto bone. Muscle weaknesses and imbalances mess with the function of the IT band and tend to create irritation. When the glutes in particular are not firing coherently and cooperatively with other major muscle groups ITB pain syndromes are a common result.

Stabilising the leg and the IT band by increasing the strength and supportive power of the leg and hip muscles is a major part of how most ITB pain syndrome sufferers get themselves from being stuck with ITB pain to being free of it in the longer term.

Beyond understanding their intrinsic importance in rehabilitating ITB pain – the key thing to understand about strength exercises is that they have to develop the right kind of strength.

If you use heavy weights on machines to increase the bulk in the supporting muscles it will only be beneficial if you perform those movements with good understanding. if you do the weights in a disorganised way the muscles will become strong in a disorganised manner – which can be counter productive – as can putting extra strain on the IT band during faulty heavy lifts.

On top of ‘brute strength’ work performed in a careful manner – most IT band pain sufferers also a havegreat need for better balance and ‘proprioception’. This type of strength helps ‘re-educates’ the glutes and other leg muscles – helping them re-learn how to support the leg and take strain off the IT band.

We live nearly our whole lives on hard flat surfaces – unlike our ancestors who were on constantly uneven and changing terrain for most of their lives. All this walking around on hard flat ground tends to make our leg and hip muscles sloppy – this is where balance and proprioception exercises for IT band come in handy for those who are looking to save their own day.


The need for orthotics also stems from the differences between an ancestrally normal existence, and a weird urbanised existence.

When you live in the big outdoors your feet tend to squish into the mud/sand/leaf litter. We call that footprints. Footprints are left when the ground conforms to the arch of the foot. In other words natural surfaces provide arch support – in other words we evolved to need arch support.

A major part of the reason for the IT band pain plague (along with the back pain – ankle pain – knee pain – hip pain – sciatic pain plagues) is the lack of ancestrally appropriate arch support we get when we move around the urban environment in fashionable footwear. Wearing custom orthotics in our shoes bridges this gap and brings massive relief to a vast number of ITB pain syndrome sufferers. The key to finding out whether you need to do the same is in depth gait analysis and biomechanical analysis of the foot – which is what we do with IT band pain sufferers at Featherston Street Pain Clinic.


Whether you have ITB pain, knee pain, hip pain, back pain, ankle pain, shoulder pain or even pain in your pinky toe – whatever effort you are willing to put into finding resolution is likely to pay off in the end. We meet people on a daily basis who have been through 10 or more different practitioners and treatments before they find one who can help them. Their stories are the reason you should continue to strive for effective management of your IT band pain – even if you sometimes feel like giving up hope.


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