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Do IT Band Straps Work for Runner’s Knee?

The science of knee straps for iliotibial band syndrome (runner’s knee)

Paul Ingraham, updated

Knee straps for iliotibial band syndrome are of questionable value.

Can a soft elastic strap make a difference? Possible. But probably not how you think …

Soft knee straps with velcro closures are often recommended for iliotibial band syndrome, a painful and common knee injury. Knee straps are intended to be worn just above the knee.1 But while it is clear that straps may have some therapeutic benefit, they are almost certainly not your best option for self-treatment of iliotibial band syndrome. In fact, they are near the bottom of the list!

On the bright side, they are also cheap and risk-free.

Read on to find out how straps are supposed to work, how well they work, and exactly what to buy and what to try.

Related Reading

Are straps “crap”?

Reader Karen McCullough wrote in to ask:

After reading your article, I thought the strap idea was probably crap. But another health care professional just told me that she’d done some research, and that the idea behind the strap was to loosen the iliotibial band on the pad of fat tissue by tightening the ITBS right above it. What do you think?

Karen McCullough, Whitewater, Wisconson

I’m such a debunker that I usually don’t have much nice to say about products like this. I’m also very skeptical about blaming pain on biomechanics.2 But in fact I actually think straps do have some potential to help — just not for the reason given by Karen’s source (and practically everyone else). There are many such “mechanical” explanations of why straps work.

Clearly there is some confusion about just what, exactly, this product is supposed to do for your knees. Even the people who sell them can’t get their story straight. But whatever the mechanism of action might be, it is almost certainly not mechanical. The idea Karen heard was wrong in at least two ways:

Other ways that a strap might help iliotibial band syndrome

Nevertheless, there is decent (albeit indirect) evidence that the strap can help! Joint function depends on extremely complex sensory input and motor output relationships. Exactly how we use our knee depends heavily on how our knee feels. The “feeling” of knee use is based on the “6th sense” of proprioception (see Proprioception, the True Sixth Sense), and involves an enormous amount of neurological data.

Wearing the strap alters proprioception in the knee and that often has a (slightly mysterious) benefit for various types of knee pain, including iliotibial band syndrome. This has been suggested by experimental results — it’s not that far out.3

And there’s another plausible neurological mechanism for relief: In chronic cases, pain may be caused as much by central sensitization4 as by any on-going problem with the tissue. There’s even interesting evidence that the stubbornness of the pain is a trait of the individual, rather than due to the state of the knee.5 The novel sensory input of the strap may force the nervous system to “reconsider” how the knee should feel.

Anecdotally, I have certainly seen some signs that the strap is helpful, although your mileage will definitely vary. Some people get absolutely no results from it, while others seem quite strongly affected. But remember, this is a cheap and easy and risk-free intervention … which means that if there is the slightest evidence that it works, it is firmly in the “worth a shot” category of treatments! There is really no reason not to try it.

I recommend that you drop in on FootSmart.com and pick their Pro-Tec Iliotibial Band strap for just $15 (USD). “One size fits most,” and they have a 120-day satisfaction guarantee, so you can return it if it doesn’t do the trick for you.

Instead of knee straps, maybe some learninatin’

Practically anyone shopping for knee straps would be better off learning more about iliotibial band syndrome first. But what to read? Who to ask? As usual for any topic, Googling for “iliotibial band syndrome” gets you an almost unbelievable number of results. Most are short, poorly written, and inaccurate.

Thanks to the misinformation explosion, myths and misconceptions about iliotibial band syndrome are even more widespread than they used to be, even among health care professionals.

Some health care professionals have taken the time to study ITB syndrome properly, of course. But it’s usually hard find one of them before your training schedule is blown to smithereens.

You get what you pay for

I have taken years of research and professional experience and put it all into a detailed, referenced article which will teach you basically everything there is to know about ITB syndrome. The information about straps offered above is excerpted from just one of sections in the article: thorough reviews of every plausible treatment options (and some implausible ones).

I do not offer a foolproof system for beating iliotibial band syndrome, because there is no such thing. But I know that you will understand this frustrating condition better than most health care professionals by the time you are done. It’s just like coming to my office and having a nice long conversation about it, where all your questions get answered.

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62,000 words
72 sections
197 footnotes

all myths & controversies
all diagnostic issues
all treatment options
  • 1 Introduction
  • 1.1 Bogus ideas about and bad treatments: IT Band syndrome myths are common
  • 1.2 IT band syndrome symptoms
  • 1.3 Are you in the right place? Patellofemoral versus IT band pain
  • 1.4 An orphan injury: IT band syndrome neglected by science
  • 2 Nature of the Beast
    What causes iliotibial band syndrome?
  • 2.1 The conventional wisdom
  • 2.2 Friction syndrome? So where’s the rub?
  • 2.3 So is it a tendon or what? IT bands are special
  • 2.4 What’s actually irritated? Not the IT band …
  • 2.5 A new surgery works without loosening anything tight
  • 2.6 The bursitis possibility
  • 2.7 Like a rock in your shoe: the mechanism of irritation and the red herring of tightness
  • 2.8 Why does IT band pain gets so nasty so fast? A vicious cycle related to running pace
  • 2.9 What are the root causes of iliotibial band syndrome?
  • 2.10 “Maybe you’re just not built for running”
  • 2.11 Where’s the fire? The inflammation myth
  • 2.12 What’s muscle got to do with it? The role of trigger points (muscle knots)
  • 2.13 Hip and thigh pain: part of the problem, or red herring?
  • 2.14 When ITBS isn’t a repetitive strain injury
  • 2.15 Does the iliotibial band move after all?
  • 3 Diagnosis
    How do you know you’ve got iliotibial band syndrome?
  • 3.1 Should you get an MRI?
  • 3.2 Knee pain getting you “down”? ITBS and descent pain
  • 3.3 ITBS vs. PFPS: A more detailed comparison, with checklists
  • 3.4 What about the hips? Could hip pain be ITBS?
  • 3.5 Could there be something else wrong, deeper inside the knee?
  • 3.6 Is patellar misalignment evidence of a tight IT band?
  • 3.7 Misdiagnosis horror story #1: Not even wrong
  • 3.8 Misdiagnosis horror story #2: The strange case of Ms. Strange
  • 3.9 Misdiagnosis horror story #3: X-ray for iliotibial band syndrome? No!
  • 3.10 Other possible diagnoses and sources of diagnostic confusion
  • 3.11 The noise, noise, noise! The significance of knee snaps, crackles, and pops
  • 4 Prognosis
    What’s the worst case scenario for iliotibial band syndrome?
  • 4.1 The risk of recurrence
  • 4.2 Special warning to hikers
  • 4.3 Can you “run through” iliotibial band syndrome?
  • 5 Treatment
    What can you do about iliotibial band syndrome?
  • 5.1 So what’s the plan?
  • 5.2 Some important things to keep in mind about placebos
  • 5.3 Steroid injections: a complicated mix of certain risks and uncertain rewards
  • 5.4 The old surgery: snipping the band
  • 5.5 The new surgery: excision of tissue from under the IT band
  • 5.6 Ibuprofen and friends: non-steroidal anti-inflammatory drugs (NSAIDs), especially Voltaren® Gel
  • 5.7 Icing: more is better?
  • 5.8 Contrast hydrotherapy: exercising tissues with quick temperature changes
  • 5.9 INTERLUDE: “I have a lot of money for you if you would just lie to me about what works”
  • 5.10 The art of rest: the biggest challenge and opportunity for patients who have supposedly “tried everything”
  • 5.11 The fear of rest, and relative resting: how to maintain fitness while protecting your knees
  • 5.12 Hip strengthening is badly over-hyped
  • 5.13 IT band massage, foam rollers, and Graston Technique® — a big fat waste of time and/or money
  • 5.14 Mis-treatment horror story: intense massage on an obviously inflamed thigh
  • 5.15 Trigger point therapy for your hips, glutes, quads, and calves
  • 5.16 Deep transverse friction massage
  • 5.17 Stretching to prevent or treat IT band syndrome
  • 5.18 The trouble with stretching the IT band in particular
  • 5.19 Some stretching hope: a better iliotibial stretch?
  • 5.20 Mobilize and stretch the hip musculature
  • 5.21 Soft knee straps (and/or Kinesio Taping) are worth a shot
  • 5.22 Orthotics for IT band syndrome: a worthwhile long shot
  • 5.23 Should you run naked? On faddish running styles and running shoes (or the lack thereof)
  • 5.24 Hitting the road: shoes, surfaces, impact, and the spring in your step
  • 5.25 ITBS and leg length
  • 5.26 Pacing: run less, but run fast!
  • 5.27 Don’t bother with Traumeel
  • 5.28 Some nuggets of wisdom about long term prevention
  • 5.29 Brief debunkery of several therapies that you should be particularly skeptical of
  • 6 Now what?
    An action-oriented summary of recommendations
  • 7 Appendices
  • 7.1 Appendix A: My own iliotibial band syndrome story … grizzly bears included
  • 7.2 Reader feedback … good and bad
  • 7.3 Acknowledgements
  • 7.4 What’s new in this tutorial?
  • 7.5 Notes
dots before headings indicate updated sections ?There’s a detailed description of all updates at the bottom of the tutorial, and it’s nice to be able to see what’s new at a glance in the table of contents. Any section updated in the last 400 days is marked (hotter colours = fresher updates).

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BUY NOW $1995 USD
Logos for Visa, Mastercard, and Amex.I accept Visa, Mastercard, and American Express. Discover and JCB are not supported for now, but I hope that will change in the not-too-distant future. Note that my small business does not handle your credit card info: it goes straight to the payment processor (Stripe). You can also pay with PayPal: for more information, click the PayPal button just below.
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If you choose to buy, thanks in advance for your business, and please feel free to write to me about something unusual or interesting about your case. I routinely make improvements to the tutorial as a result of feedback from runners and readers and health care professionals around the world.


You can also keep reading for free! Other free samples from the book and closely related articles on PainScience.com:

What’s new in this article?

2016Miscellaneous minor improvements, repairs, and modernization. It had been at least 7 years since this article got some attention! Yoinks. 😮 Added brief discussion of the role of central sensitization.

Notes

  1. Below-the-knee straps probably have little relevance to iliotibial band syndrome: they are much more commonly recommended for different conditions, namely patellofemoral syndrome and jumper’s knee. BACK TO TEXT
  2. “Structuralism” is the excessive focus on causes of pain like crookedness and biomechanical problems. It’s an old and inadequate view of how pain works, but it persists because it offers comforting, marketable simplicity that is the mainstay of entire styles of therapy. For more information, see Your Back Is Not Out of Alignment: Debunking the obsession with alignment, posture, and other biomechanical bogeymen as major causes of pain. BACK TO TEXT
  3. Callaghan MJ, Selfe J, Bagley PJ, Oldham JA. The effects of patellar taping on knee joint proprioception. J Athl Train. 2002 Mar;37(1):19–24. PubMed #12937439.  PainSci #57070. 

    This article provides an important clue that may help to rationalize the use of a “Patt Strap,” “Cho Strap” or “iliotibial band syndrome strap,” and also suggests a possible mechanism for therapeutic effect on patellofemoral syndrome in particular, as well as other problems. This evidence suggests that proprioception is enhanced by patellar taping. From the abstract: “Subjects with good proprioception did not benefit from patellar taping. However, in those healthy subjects with poor proprioceptive ability ... patellar taping provided proprioceptive enhancement.” Ten years later, the same researchers demonstrated that brain activity is modulated by taping (see Callaghan 2012).

    BACK TO TEXT
  4. Pain itself can change how pain works, so that patients with pain actually become more sensitive and get more pain with less provocation. For more information, see Sensitization in Chronic Pain: Pain itself can change how pain works, resulting in more pain with less provocation. BACK TO TEXT
  5. Neogi T, Frey-Law L, Scholz J, et al. Sensitivity and sensitisation in relation to pain severity in knee osteoarthritis: trait or state? Ann Rheum Dis. 2015 Apr;74(4):682–8. PubMed #24351516.  PainSci #53256. 

    In more than 2000 people with knee osteoarthritis, or at high risk for it, pain sensitization was associated with knee pain, but not the severity of arthritis as seen on x-ray. Neither pain nor sensitivity clearly correlated with the condition of their knee.

    This contradicted the researchers’ expectation that sensitization is driven by the duration and severity of arthritis. Instead, the results suggest t:

    sensitization is in fact a ‘trait’ rather than a ‘state’, that is, that hypersensitivity was present before knee osteoarthritis, related to an individual’s predisposition to sensitization rather than being induced by peripheral nociceptive input [pain] from osteoarthritis.

    Even more simply stated: people with knee pain have a problem with pain itself, not knees, to at least some extent.

    BACK TO TEXT