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Side of your
knee hurt?

IT band syndrome is a common & often persistent knee injury, causing pain mainly on the side of the knee.

How I (Eventually) Recovered from IT Band Pain (Runner’s Knee)

The story of how I got a nasty case of chronic IT band syndrome in both knees & then studied the condition intensively so I could finally beat it

updated (first published 2009)
by Paul Ingraham, Vancouver, Canadabio
I am a science writer and a former Registered Massage Therapist with a decade of experience treating tough pain cases. I was the Assistant Editor of ScienceBasedMedicine.org for several years. I’ve written hundreds of articles and several books, and I’m known for readable but heavily referenced analysis, with a touch of sass. I am a runner and ultimate player. • more about memore about PainScience.com

This is my knee pain story. I am a former massage therapist in Vancouver, Canada. I am also an athlete, a writer, and I publish this large website about common pain problems that are often ineffectively treated — especially IT band syndrome, one of my own most difficult injuries. This is the story of how backpacking like an idiot gave me IT band syndrome, and my recovery as a runner.

I was struck by an extreme case of iliotibial band syndrome in both knees at once, on a solo backpacking trip in the Monashee Mountains of Canada, in the spring of 1998. For extra excitement, I even had a close encounter with a grizzly bear on that trip.

But that makes me sound more adventurous than I am.

The truth is, I am a big chicken. Many of my readers are far more “extreme” athletes than I am! Being in the woods alone spooked me — I had never attempted solo backpacking before. I got injured because I was foolish and nervous. I pushed too hard, too fast, and ended up deep in the mountains late in the day, with the trail ahead lost in snow, and the trail behind too long to retrace before nightfall.

No one had a clue where I was, and no one else was out there. This sort of situation can absolutely get you killed. It was all very Aron Ralston (127 Hours) of me.

The Monashee Mountains: This is where I got iliotibial band syndrome! <em>And</em> had a close encounter with a grizzly bear.

The Monashee Mountains

This is where I got iliotibial band syndrome! And had a close encounter with a grizzly bear.

I decided I wasn’t going to pitch a tent on the trail, and I would push to get back to the trail head … even if I had to hike in the dark for a while. I practically ran down the mountain with a fifty pound pack — big mistake!

After just an hour, both my knees started to scream with my first case of IT band syndrome. It would have been smarter to stop and camp, however dark and spooky the forest was, but my nervousness drove me onward. I just wanted to get back to the safety and security of my car!

The rest of the return hike was a knee pain nightmare. It certainly ranks as one of my most painful experiences. There were times when I felt certain I couldn’t take another step … yet somehow I did, because I knew there was an even bigger risk lurking in the dark.

Let’s take a detour and tell the grizzly part of the story. It doesn’t have much to do with knee pain, but it’s just so entertaining. I’ll tell the story in a few paragraphs and then get back to the knee pain.

The grizzly!

Rawr!

Not the actual grizzly I met … but there’s a resemblance.

As if I didn’t have enough reasons to be nervous already, there had been a warning sign at the trail head about a mother grizzly with four cubs in the area. I’d spoke with the leader of a Girl Scout group who said, “Don’t worry about her, she’s here every year — just make noise.”

But I hadn’t counted on being back at the trail head after sundown!

So I was on high alert as I neared the trailhead. And I was almost home free, my knees burning like twin suns, when the momma grizzly found me.

Unfortunately, alertness was pointless. It was deep twilight, and there was nowhere to run, and I couldn’t run anyway, and no one out runs a grizzly even on fresh legs. She charged me on the trail, and I heard her before I saw her.

I swear I thought the following two thoughts, in this order, and I have told this story exactly like this ever since it happened:

  1. I guess I’m going to be maimed and killed now. Damn. This is going to hurt.
  2. At least I won’t have to walk any further on these knees!

And that was all I had time for. Grizzlies are fast! (Up to 34 mph, 55 kph.) She came at me like I was lying at the bottom of a cliff and she was falling on me. The idea of unlatching my bear spray from its “quick” release on my belt, pulling the safety pin, aiming, and firing … absolutely ridiculous! I think the reflex to reach for it didn’t kick in for about ten minutes. She was simply way too fast and intimidating.

And she did what grizzlies almost always do when they charge people: she veered off at the last second. I am eternally grateful, for the sake of my ego, that I somehow managed not to soil myself. When I started to move again, my knees barely worked at all. I took several minutes to cover the short distance to the parking lot. Soon I was in my car and driving back to civilization. Despite my escape, however, my ordeal was nowhere near finished: my knee pain had only just begun.

And that’s my bear story! It’s given me years of dinner-party material, and it will for the rest of my life. Now, back to iliotibial band syndrome …

The worst onset of iliotibial band syndrome ever?

Over the last ten years, my publications about iliotibial band syndrome have exposed me to literally thousands of case studies of severe iliotibial band syndrome from around the world. To this day, I still haven’t heard of a case with as nasty (or colourful) a start as my own. I win the prize for worst ITBS onset ever.

Yay for me.

Due to the napalm attacks on the sides of my knees, I quite literally could not get down stairs — which was problematic, because I lived on the third storey of an old mansion. It was about three days before I could get down. A friend brought me some groceries.

What an education in ITBS! One “good” thing about a severe case of anything is that signature symptoms tend to be really clear. Things that are subtle in a mild case become screamingly obvious in a severe case. For a therapist, having a bad case of something yourself means that you get a vivid picture of the condition. And this was classic IT band syndrome: savage hot epicentres of pain right on the sides of the knees … and dramatic spikes of pain every time I tried to take a step downwards.

But I didn’t know what I had, yet.

I learned basically nothing about iliotibial band syndrome in school

I was in the midst of my massage therapy training at that time. Massage therapy training in my part of Canada is quite advanced (similar to training for physiotherapists and chiropractors, but just three years instead of four).

Despite the intense curriculum, we hadn’t learned diddly or squat about iliotibial band syndrome, and nor would we later. ITBS barely got more than a mention in three years of studying. Most health professionals are equally poorly informed about this frustrating condition.

It’s laughable now to think that I could have ever learned anything detailed about IT band syndrome rehabilitation. If I hadn’t been forced to learn more, I doubt I would even have realized how little I knew.

The long road to IT band pain relief

It took me more than a year to recover, and I suffered flare-ups for several more years, although they became increasingly manageable. During that time, I experimented thoroughly with all the conventional treatment methods, and a few unusual ones, and I studied ITBS intensively. At least, it seemed like a lot back then.

Textbooks were as useless as my training had been — I’ve never found a book with more than a paragraph or two of stale old conventional wisdom about IT band syndrome. They are outrageously inadequate. I had to study the scientific research directly, searching databases like PubMed (still a new-fangled internet thing back then).

When the going gets tough, the tough go to the scientific literature.

[Athlete with iliotibial band pain, playing ultimate.]

That’s me, getting ready to flick the disc, back in 2001 or so.

And so, by the time I had graduated from massage therapy college in 2000, I had probably already forgotten more about IT bands than any of my classmates would ever learn in the first place. Going to a therapist or a doctor for help was a joke: I knew ten times more than any of them. I was my own therapist. I had to be!

I am an enthusiastic ultimate (Frisbee) player, so the injury was deeply frustrating to me. It’s a sport that inspires fanaticism. Just like every serious runner I’ve ever treated, it was nearly impossible to keep me from re-injuring myself. I simply would not stay off the field. Every return to play was premature. This was where I first made the observation that runners (and ultimate players) are often more of a problem than their knees. Iliotibial band syndrome isn’t stubborn — we are!

So … how did I actually beat iliotibial band syndrome?

I am not going to completely give that information away here! A fellow has to make a living, and I do it selling books about pain problems. But here’s a rough outline:

IT band syndrome is not generally stubborn because of its severity — it’s stubborn because, like a rock in your shoe, there’s no easy way for it to get less irritating. It’s almost impossible to stop stressing the irritated tissues, giving them a chance to calm down. So, for me, the magic bullets were mostly “strategic” resting — most athletes do not rest “smart” — plus megadoses of well-timed icing, plus the discovery that one of the taijiquan movements I knew was much better at stretching the iliotibial band and associated musculature than any of the conventional IT band stretches (which are amazingly useless, by the way).

IT band stretches do not work as advertised.

What’s wrong with this picture?

She’s is not actually doing much of anything to her iliotibial band with this classic IT band stretch. Even if her technique was good (which it isn’t), she wouldn’t be doing much good.

How did I know that stretch was so effective? Because it hurt like hell. With my extreme case and ultra-sensitive knees, it was quite easy to test how different IT band stretches pulled on my screaming iliotibial band! So, for instance, this is how I first learned the importance of knee flexion in stretching the iliotibial band — a difference that was as clear to me as flicking a light switch. (This is clarified in my full tutorial.)

Becoming an IT band expert

By 2001, I suppose I thought I knew quite a lot about IT band syndrome. But in fact my journey to “expertise” had only just begun. I had only just started working with patients, and I had thousands of hours of study and writing still ahead of me.

ITBS patients seemed magically drawn to me, as word spread that I knew a thing or two about the condition. In 2002, I published a short article here on PainScience.com about it for my own patients. And then I started really researching. The article grew into a full-fledged “tutorial,” and then it got book big.

I put a price tag on it in 2007 — I was working at least 70 hours per week moonlighting as a researcher/writer, and I had to start charging for the information to fund the kind of academic perfectionism I was getting into.

Today the iliotibial band syndrome tutorial is simply the most exhaustive source of information available about iliotibial band syndrome, period. If there is anything even remotely like it, I’ve never found it. And it’s still growing and improving, after all these years.

And you can start reading it now. You can read the first few sections of the tutorial for free. You will then be asked to pay USD$1995 to continue reading it. Or you can just go ahead and buy it immediately, right here. It’s all digital, the store is secure and simple (no password or account required), and you’ll be reading the rest of the tutorial in a couple minutes. An important companion tutorial about muscle knots (myofascial trigger points) is also included, free.

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61,000 words
75 sections
192 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
  • 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).

I really appreciate your objectivity. ~ Dr. Bryan Allf, MD, North Carolina

Very much improved since reading your tips and admonitions ... ~ Leanne Schultz, runner, Victoria, Canada

I appreciate your research on this subject, and that you have clearly debunked lots of poor quality ‘science.’ ~ Sukey Jacobsen, Mount Vernon, Washington

Keep reading for free! Other free samples from the book and closely related articles on PainScience.com:

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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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The main buy button is for credit card purchases, but some customers prefer to use PayPal so they don’t have to give a credit card number to a small business. However, my business never actually handles card info: it goes straight from your web browser to Stripe.com [opens new tab/window], a major payment processor with a great reputation. So using a credit card here is as safe as using it in any store, probably safer.

But you can pay with PayPal. Although automatic order processing is only available for credit card customers, you can “manually” login to PayPal and send payment of 19.95 USD to . Please specify the book you are ordering!

I process orders promptly during working hours, usually within two hours, often much less; night orders are processed early the next day. You will receive order confirmation and access information by email.

Important reminders!

  1. Confirmation emails are often mis-identified as junk email. If you don’t get yours, please check your spam folder!
  2. Again, please specify which book (just the topic is fine, e.g. “plantar fasciitis”).
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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.