One of the most common injuries experienced by runners and walkers is Ilio-Tibial Band Syndrome, a painful tightening along the outside of the thigh that can bring your run or walk to a halt if left unchecked. This article will explain what causes this painful injury and how you can apply your ChiRunning and ChiWalking focuses to correcting the problem at the source and continue running and walking pain free.

What is an IT band?

The Iliotibial Band is a thick fibrous band running along the outside of the leg from the hip (ilium) to the shin bone (tibia) just below the kneecap . . . like a stripe down the side of your leg. In the hip area a muscle joins the two ends of the band together (the tensor fascia latae), which you can see just under the shorts on many lean runners and walkers (see drawing below). The band's job is to hold the upper and lower parts of your leg stable when your knee bends. Specifically, it works with the muscles on the inside of your thigh to keep your knee from collapsing inward on every step.

What is IT band syndrome?

IT Band Syndrome is a repetitive use injury that occurs when the band tightens up, often because of too much side-to-side rocking of the hip. As the band tightens up, each step can pull it tighter across the bones of the knee joint and actually rub on the outer part of the knee.

Here is what it feels like

The rubbing can cause inflammation and pain, usually around the outside of the knee (see the star in the drawing above), though you may not see swelling, and the pain can be enough to stop you in your tracks. Even if you don't experience knee pain, the band may be tight enough to be tender all along the outside of your thigh. Often the pain may not appear until you are a mile or two into your workout, and may feel worse as you continue or when you run or walk down hill or down stairs. Many times the pain will subside if you stop running momentarily and walk with very short steps. That's because walking minimizes the rubbing of the band over the joint. Most often IT band problems occur at the knee, but you may also feel discomfort higher up in that tensor muscle, and all along the IT band due to its tightness.

Here are the activities that can cause or aggravate it

One of the most common causes of IT band soreness happens in runners and walkers whose pelvis sways side to side with each step. (An exaggeration of this motion would be a model walking down a runway.) Any lateral (sideways) movement of your pelvis will tighten your IT band because, as your foot lands under you, your hip moves sideways. This will not only stretch the IT band, making it sore, it can also aggravate the bursa of the hip and create hip bursitis.

Another common cause of IT band tightness is running or walking with your toes pointed outward. This causes the foot to pronate or roll inward excessively as your heel strikes the ground, making the IT band work harder to control the inward motion. Other factors include landing on your heel out in front of your body, especially when running or walking downhill, which accentuates that hip rocking motion; running or walking in the same direction on the track, or running or walking mostly on a side-sloped road; and running or walking in shoes that are too cushioned. Any tightness in your leg muscles can make IT symptoms worse, and symptoms may also appear after ramping up your mileage too quickly.

Here is what you can do about it

The first thing you can do to help your IT band feel better is to focus on keeping your pelvis level, front to back and side to side. To get an idea of how this should feel, try walking a few steps "runway style," really let those hips rock! Notice how your knees collapse inward when you walk this way (don't do this for more than a few steps; we are just trying to exaggerate the hip rocking feeling so that you can sense when you are holding them stable in the next step.) Now establish your posture and level your pelvis by lifting up the front part (pubic bone) with your lower abdominals until it is level. Imagine your pelvis is a bowl of water and you want to keep it from spilling. Walk forward holding your pelvis stable and notice that your hips do not move laterally with each step, and that your knees do not collapse inward.

If you are new to ChiRunning or ChiWalking you may need more direction on how to establish your posture correctly and how to level your pelvis. You can read about it in either of the books or get clear visual direction from either the ChiWalking or ChiRunning DVD.

Once you get the feel of holding your pelvis level, add in this second component. Allow your pelvis to rotate around a vertical axis running through its center. Here's an easy way to get this to happen. Every time your leg swings to the rear, let it pull your hip to the rear along with it. Your entire lower body will then be swinging in the direction of your rear leg while your upper body remains facing forward. This will allow your stride to become longer and more fluid, without letting your hips move laterally.

Find a very gentle hill to run down. Leaning forward as you head down the hill, try to sense what it takes to keep your pelvis level now that your body is tilted down the hill. Let your heels come up behind you and let your pelvis rotate to lengthen your stride and absorb shock, rather than letting your quads get pounded by the hill.

Another ChiRunning and ChiWalking focus to apply is making sure your feet are landing directly under your body or even slightly behind it for runners. Runners should be landing midfoot under your center of mass and walkers should strike just in front of the heel. This will help keep the IT bands from overworking.

These focuses can be done even while you are recovering from IT band problems, because of the "instant feedback" nature of the condition: when we stop the conditions that cause the inflammation and rubbing, the band rewards us with no pain! This allows you to use your body-sensing skills to get feedback on which adjustments make the pain go away.

If your IT band area is so sore that every step hurts no matter what, you may want to ice the inflamed area at the knee and massage the rest of the tight band area. The foam roller does a nice job of this massage-this may hurt but it will really help.

Lie on your side with the outside of the affected leg on the foam roller about halfway down the thigh; roll up and down until you find a sore spot, then stop and rest on that spot until the pain reduces by 75%--it takes a few seconds. Breathe. Move to the next tight spot and repeat. Do this on both sides, even if you don't have IT band syndrome in both legs.

It may be a good idea to shorten your runs or walks while you are recovering, and use these sessions to work on your body- sensing skills so you can determine which changes and focuses take away the pain. If you run or walk at the track, change your direction often such as every two to three laps, or do your interval sets counterclockwise and your recoveries the other way. If you run or walk on the paved roads, avoid the most sloping part of the road near the shoulder. Wear footwear that has the right amount of cushioning and support for your body type and running or walking form. See our guide to footwear.

IT band syndrome is painful but is easily cured by applying a few ChiRunning and ChiWalking focuses: specifically keeping your pelvis stable so that it does not rock side to side and landing directly under your body with your toes pointing straight ahead. Listen to your body as you apply these focuses and your IT band problems will be just a distant memory as you run and walk pain free.

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