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Iliotibial Band Syndrome (ITBS) is the bane of runners and cyclists. It presents as a sharp, stinging pain on the outside of the knee, or sometimes a snapping sensation at the hip. It often starts a few miles into a run and gets progressively worse until you are forced to stop.
For decades, the advice has been “roll it out.” Athletes spend hours in agony on foam rollers, trying to stretch the IT Band.
Here is the truth: You cannot stretch the IT Band. It is a thick sheet of fascia, as tough as a car tyre. Studies show it would take mechanical machinery to stretch it even 1%. Furthermore, the IT Band is supposed to be tight. It acts as a spring to store energy.
At Breakthrough Pain & Performance, we stop the rolling and start the thinking. The IT Band becomes painful because it is being compressed against the bone due to poor biomechanics. It is a victim of what is happening at the hip and the foot. We treat the neurological control of the leg to stop the friction and resolve the pain.
The most common cause of ITBS in runners is a Crossover Gait. This is where your feet land across the midline of your body (like running on a tightrope).
This narrows your base of support. It forces the hip into adduction (inward angle). This pulls the IT Band tight against the side of the knee (femoral epicondyle). With every step, the band rubs against the bone. After 5,000 steps, you have a friction burn.
Why do you run like this? Often, it is a lack of Proprioception. Your brain doesn’t know where your feet are landing. We use gait retraining. We teach you to widen your stance slightly. This simple change opens the hip angle and instantly takes the pressure off the IT Band.
The IT Band is attached to two muscles at the hip: the Tensor Fascia Latae (TFL) at the front and the Gluteus Maximus at the back. These two muscles fight for control of the band.
In most runners, the TFL is dominant and tight (often due to sitting), while the Glute is inhibited and weak. The TFL pulls the IT Band forward and tightens it excessively.
You cannot relax the IT Band, but you can relax the TFL. We use P-DTR to reset the tone in the TFL muscle. We then wake up the Glute Max. When the Glute is firing, it pulls the IT Band posteriorly, which is its optimal line of pull. This rebalancing act stops the irritation at the knee.
Recent research suggests that ITBS is not caused by friction (rubbing) but by Compression. Underneath the IT Band at the knee, there is a highly sensitive pad of fat (a bursa). When the band is pulled tight, it crushes this fat pad.
The fat pad is innervated. It hurts. Foam rolling the side of your leg compresses this fat pad further, often making the pain worse.
We focus on Decompression. We stop the habits that squash the tissue (like crossing legs when sitting). We use manual therapy to lift the fascia away from the bone, creating space for blood flow and healing.
If your pelvis drops on one side when you land (Trendelenburg Sign), it hikes the tension in the IT Band. This pelvic drop is caused by a failure of the Gluteus Medius muscle.
However, doing clam shells on the floor rarely fixes this. The Glute Medius needs to fire reflexively in a standing position to stabilise the pelvis.
We use Dynamic Stability drills. We train the glute to fire while you are standing on one leg, often with eyes closed to challenge the brain. By stabilising the pelvis, we stop the “wobble” that whips the IT Band tight.
For cyclists, ITBS is often a setup issue. If your saddle is too high, you have to extend your knee too far at the bottom of the pedal stroke. This causes the IT Band to snap over the bone with every revolution.
If your cleats are angled incorrectly (toes in), it twists the tibia and strains the band. We assess your mechanics on the bike. Small adjustments to equipment can have a massive impact on tissue load.
1. The Release: We release the TFL and Lateral Quad to reduce tension on the band.
2. The Activation: We wake up the Glutes (Max and Med) to control the hip.
3. The Technique: We use video analysis to widen your running gait or adjust your bike fit.
4. The Return: We guide a graded return to running. We stop before the pain starts to avoid re-irritating the fat pad.
This clinic is for you if:
We provide a scientific, mechanical solution.
