Running again: How I returned to racing after two decades of IT band pain
Finishing a 70.3 Ironman includes running a 13.1-mile half marathon. I had to get past two decades of IT band pain to do it.
For 20 years I suffered from iliotibial band knee pain and couldn’t run. Here’s how I finally moved past it at age 50 and tackled my first half-marathon and half Ironman courses.
When I was in my early 30s I started training for a sprint triathlon, something I’d never done. Without a clear training plan, I ran, biked, and swam in the mountains of Idaho and pretty quickly got strong. The problem was that I’d never trained as an endurance athlete and had no concept of how to pace myself.
My heart and lungs became strong enough to go for hours-long jogs in the mountains, and I enjoyed the endorphins while out among pine trees, sagebrush, and deep blue skies.
I didn’t think much of it when my knees started hurting. My only injuries at that age had been from sudden traumatic events, and whatever pain worked its way into my joints generally also worked its way out.
So I kept running, and the pain got worse until I was barely able to walk. I realized the issue wouldn’t work itself out and that running was, at best, preventing recovery and, at worst, causing the problem.
What I didn’t realize at the time was that I’d developed an injury that would stick with me for two decades to come. Over the ensuing 20 years I never ran more than about a mile without the outsides of my knees flaring up.
Doctors and physical trainers who I’ve visited over the years, easily identified the issue as iliotibial band (ITB) syndrome. At their suggestions I deployed an arsenal of focused stretching and foam rolling techniques to fix it.
But nothing worked.
Every time I laced up a pair of running shoes, I made it about 0.7 miles and started to feel the telltale signs of IT band pain. Then I’d stop and walk home.
Last year, a full 20 years after my first IT band injury, I ran a half marathon, did a half Ironman triathlon, and climbed 50 summits over hundreds of miles in the mountains. Here’s how I got past 20 years of pain and back into long-distance running and hiking.
What is IT Band Syndrome?
The IT band is a band of connective tissue that runs close to the skin along the outside of the leg from the hip to the knee. It plays a role in stabilizing the knee and hip during movement.
IT Band Syndrome, or Iliotibial Band Syndrome, occurs when the band gets inflamed or irritated due to repetitive friction, which occurs during activities that involve repetitive knee flexion and extension. These activities include running, bike riding, hiking, and more.
Causes of IT Band Syndrome
Routine stretching can be part of an IT band prevention and recovery strategy, but I found that correcting muscle imbalances helped even more.
The medical literature is pretty clear that IT Band Syndrome typically stems from overuse, biomechanical issues, or both. It’s extremely common among runners due to the sheer volume of repetitive motions involved. As with many other running injuries, it’s especially common when runners suddenly increase intensity or duration, as was the case with me.
Biomechanical factors, such as improper running form, muscle imbalances, or worn-out footwear, can also contribute to IT band pain.
As I’ll explain below, I believe my IT band problems were due to three key factors: an underlying muscle imbalance, biomechanical factors caused by another activity I used to do a lot, and the sudden high mileage I added to my training routine when I decided to compete in a triathlon.
IT Band Syndrome symptoms
In my experience, IT band pain is difficult to detect when it first flares up. I only became good at detecting the first subtle signs after decades of wrestling with the condition.
It starts as a very subtle pain on the outside of the knee and gradually worsens with continued activity, and improves with rest. At its worst, IT band pain makes walking even a few steps painful, and it’s especially painful when walking downhill or going down stairs.
It can be truly debilitating, and on days when you’re committed to continued activity (like backpacking or alpine climbing), the condition can slow your progress to a figurative crawl.
According to The Cleveland Clinic, people often describe IT Band symptoms as sharp or burning, with possible clicking in the outside of the knee. Pain is most common on the outside of the knee and lower thigh but may radiate anywhere along the length of the band, which runs along the outside of your thighs from the knees to the hips.
Diagnosis of IT Band Syndrome
Getting ready for my first race in two decades, the Fit One Half Marathon in Boise, Idaho. I finished in 1:50 with no IT band discomfort.
It’s easily possible to diagnose IT Band Syndrome by yourself, but as happened with me in my early 30s people wrestling with the condition for the first time might need a professional to point it out. Doctors, physical therapists, and athletic trainers are all qualified to diagnose IT Band Syndrome.
Treatment for IT Band Syndrome
For me treating IT band pain was a matter of trial and error that took 20 years. Before I describe my journey in detail, I must point out that the best treatment for you likely involves a plan prescribed by your healthcare provider.
Treatment for acute IT band pain is similar to that of other soft tissue injuries and involves reducing pain and inflammation. Treatment for chronic IT band pain involves identifying muscle imbalances, biomechanical issues, or training habits that need to be addressed.
Here’s what that looked like for me.
Muscle imbalance: When stay-at-home orders were issued during the COVID-19 pandemic, I started an exercise routine that at first involved a lot of bodyweight and band-resisted exercises. This included a range of motions like clamshells and side leg raises that hadn’t been part of my normal workouts.
This strengthening of the muscles around my hips—especially my butt muscles, and most especially the gluteus medius—make a difference for my IT bands, and I started going for short runs once every few weeks. It had been so effective I looked for more information about how to correct the long-term problem.
I found an IT band-specific video by personal trainer and physical therapist Jeff Cavaliere that went straight to the core of the muscle imbalance I’d been wrestling with. It’s the best single resource I found in 20 years to help resolve my IT band pain. The strength training exercise he recommends only requires a band and has become part of my training routine at least a few times per month.
Whitewater kayaking and running might not seem like they’re related, but I believe the unique position you sit in a kayak contributed to my long-term IT band pain..
Biomechanical issues: With hindsight, there’s another obvious contributor to my two decades of IT band pain, and that’s the amount of time I spent in a whitewater kayak. From May through September, I used to kayak three to five times per week, and I kayaked that much for more than a decade.
Modern kayaks have gotten pretty comfortable, but sitting in a kayak involves pushing your legs into a unique position in which your feet are braced on a footrest, and your knees are flared and pressed into the kayak sidewalls just under the deck. This twists your hips and IT bands in a unique way.
Kayaking 50 or more days a year was great for my shoulders, core strength, and sense of adventure, but I believe it also contributed to my IT band problems. It’s difficult to say with certainty whether strengthening my butt muscles, not kayaking as much, or both made the biggest difference.
While my biomechanical issues resulted from spending a lot of time in a unique position, it’s important to point out that biomechanical issues could result from a wide range of underlying causes—including individual body geometry and a range of activities that could adjust posture or muscle tightness—and identifying them may involve consulting a medical professional.
Return to running after IT band pain
Running places a variety of demands on the body, and returning to running after any injury should be done gradually. As symptoms subside and mobility improves you can reintroduce running and gradually increase your mileage.
Start by running short, low-impact runs on flat surfaces, and then gradually increase your distance and intensity. Play close attention to signs of discomfort or pain during and after your runs, and adjust your training accordingly.
I started by running one mile at a time one time per week, and maintained that routine for a month or more before increasing my distance and duration. As indicated at the beginning of this article, the end result was completion of several half marathons and a half Ironman triathlon, as well as a renewed love for an activity I thought I’d left behind.
Getting past the pain
IT Band Syndrome can significantly impact your ability to participate in physical activities, but with proper understanding and management, its effects can be mitigated—even in cases like mine where it took 20 years of trial and error to get there.