When discussing what exercises you should do for iliotibial band syndrome (IT band syndrome), a good place to start is to look at what other factors you should keep in mind before you do a specific exercise. In this article, we’ll explain what factors you should keep in mind when structuring your IT band rehab programme and what exercises you should include, depending on your goals and your IT band’s stage of recovery. Remember, if you need more help with an injury, you're welcome to consult one of our physios online via video call.
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Factors that influence the choice of exercises for IT band rehab
1. What caused your IT band syndrome?
We’ve previously explained that IT band syndrome develops when the IT band experiences excessive compression forces where it crosses over the outer knee. The excessive compression can be caused by one or more of several factors (tight muscles, weak gluteal muscles, fatigue, overpronation, running terrain, etc.)
For an IT band rehab plan to be successful, it has to address the cause of your injury. For instance, if your specific case was caused by overpronation, you can do glute exercises until the cows come home and may see no effect. But if you add in exercises that specifically improve the strength and stability around the ankle, you may notice some progress.
Or it may be that your case was cause purely by training error and that muscle weakness or control had nothing to do with it. In that case, you really need advice about restructuring and planning your training better.
This is why it’s useful to consult a physio so that they can help you identify your specific cause and compile a rehab plan that takes all the relevant factors into account.
2. How irritable your injury is
A newly injured IT band can be quite short tempered and easy to aggravate. The exercises you do (movement patters, weight, volume) should change depending on how sensitive or irritated your injury is. If not, you may end up irritating it further or, if you’re too conservative, you may not see any progress. We explain this in more detail in the specific exercise sections below.
3. Your exercise goals
IT band rehab can look very similar for everyone during the early stages. However, as their injuries heal and they progress to more intense and complex exercises, the choice of exercises should be influenced by what sports they want to get back to as well as at what level they want to do it.
For example, if you’re a runner or do a jumping sport, your legs will have to deal with much stronger forces than those of someone who just wants to go for walks. Also, your programme should definitely include exercises that develop landing mechanics (plyometrics), whilst this is not really needed for a walker. If you’re a footballer, you will also have to retrain your control when changing directions quickly, whereas a regular runner doesn’t really have to worry about that.
Stretches for IT band syndrome
This is a topic that warrants a blog post and video of its own. You can read all about what muscles to stretch and what stretching pitfalls to look out for when you do stretches for IT band syndrome in this article.
Glute exercises for IT band syndrome
Your glutes (glute max, glute med, glute min) all work together to help stabilise your pelvis. They stop it from dropping to one side when you walk, run, or jump. The IT band is also attached to the pelvis. If your glute muscles are weak and allow your pelvis to drop excessively, this then pulls on the IT band and can cause increased compression at the side of the knee.
What glute exercises are best for IT band syndrome?
It will depend on how irritable your knee currently is.
If your IT band is still very sensitive or newly flared up, then it is usually best to avoid:
Exercises that require repetitive bending and straightening of the knee (like squats);
Exercises that require a lot of control (like lunges or balancing on unstable surfaces);
High load exercises (single leg standing).
Glute exercises that can work well for the early stage of rehab include: Clams, side leg lifts, and isometric bridges (double support). We've includes instructions for these lower down.
As your IT band settles down and recovers, you can add in more high load exercises like single leg bridges, squats, and deadlifts. Squats are brilliant because not only do they build good glute and general leg strength, they also help you retrain good movement patterns. But they should only be added once you can do them pain free.
Clams
Start without a band. You can add the exercise band later as a progression. If it hurts to place the band above the knee, you can move it to just below the knee.
Instructions:
Lie on your side with your hips bent to about 60 degrees and your knees at a 90-degree angle.
Tighten your stomach muscles to help stabilise your trunk during the movement.
Keep your feet touching each other while you rotate your top knee up and back down, so that your legs open and close like a clam.
Check that your pelvis or hips don't roll back as you lift your leg.
Hold the open position for 2 seconds and then SLOWLY lower your leg back down.
Your aim is to do 15 repetitions, but don't force it. If you find it hard, do what you can and just add a few repetitions the next time as you get stronger.
Rest 60 seconds.
Do 3 sets.
Side leg lift
Instructions:
Lie on your side with your head supported and lower leg bent.
Contract your core and slowly lift your top leg up.
Make sure that your leg does not drift forward during the exercise - you should only be able to see the tips of your toes if you look down at your foot.
Also make sure that you don't roll back - your hips must stay vertical.
You may not be able to lift your leg very high, and that's OK.
Slowly lower it back down.
Do 15 slow lifts and lowers.
Then rest for 60 seconds.
Do 3 sets.
Isometric bridge
Instructions:
Lie on your back with your knees bent 90 degrees and your feet flat on the floor.
Lift your bottom off the floor until your hips form a straight line with your trunk.
Concentrate on squeezing your buttocks to get you up there.
At the same time, tighten up your lower stomach muscles and avoid arching your back too high.
Hold the position for 20 seconds.
Then lower back down and rest for 20 seconds.
Repeat 5 times.
Foot and ankle exercises
Overpronation (when your foot rolls in excessively) can cause your lower leg to turn in excessively. Because the IT band attaches onto the shin bone, this can also cause the IT band to pull tight and compress more than normal against the outer knee.
By strengthening the muscles that control and support your foot and ankle, you may help reduce the overpronation or the force with which your foot moves into pronation.
What foot exercises work best for IT band syndrome?
The same principles apply as for the glute exercises. If your knee is very irritable, you want to start with exercises that don’t place a high load through your leg and also don’t require a lot of repetitive bending of your knee.
Examples of good starter exercises are towel grabs and inversion (turning foot in) against a resistance band. The towel grabs strengthen the small muscles inside your foot that support your arch. The resisted inversion exercise strengthens your tibialis posterior muscle, which is one of the main ones that control pronation at the foot and ankle.
Towel grabs
Instructions:
Sit on a chair - it works best if the floor is slippery or smooth.
Place your foot on a towel and use your toes to gather in the towel.
Do 20 "towel grabs".
Then rest 30 seconds.
Do 5 sets.
Resisted inversion
Instructions:
Sit on a chair with one end of an exercise band attached to the leg of the chair and the other to the front of your foot (same side foot and chair leg).
Cross your legs over to increase the resistance on the band.
Now slowly turn your foot in against the resistance.
Pause for 1 second.
Then slowly turn it back out, controlling the movement so that your foot doesn't jerk back out.
Repeat 10 times.
Rest 1 minute.
Do 3 sets.
As your knee pain settles, you should then include exercises that develop your ankle control in positions that resemble the walking, running, and jumping movement patterns. The good news is that most of these exercises also strengthen your glutes, so you can get lots of benefit from doing just one exercise.
Balancing on one leg is a good example of an exercise that requires your glutes to work in order to keep your pelvis level, and also your ankle and foot muscles to work to control your ankle and foot. A single leg squat is another great all-in-one exercise, but these should only be used much later in rehab, once your symptoms have fully settled.
Exercises that retrain movement patterns
Sometimes you may have pretty strong glutes and ankle muscles, but your legs still turn in excessively when you walk, run, or jump. If this is the case, you may benefit from retraining your movement patterns (biomechanics).
The research has also shown that, even in cases where muscles are found to be weak, strengthening the key muscle groups (like the glutes) doesn’t automatically translate into better movement patterns; you still have to retrain the movement itself.
What is a ‘good’ movement pattern?
First, it’s important to understand that there’s not such thing as a perfect movement pattern, and that various patterns are acceptable. When we look at movement, the elements that have been indicated that might be important for IT band syndrome are to avoid:
Excessive pelvis drop;
Excessive leg internal rotation (the thigh and lower leg turn in too much when you step or land);
Excessive adduction (the thigh moves too far over to the mid-line)
You’ll notice the word “excessive” in all three bullet points above. The reason for this is that it is absolutely normal to see some drop in the pelvis and you should get some internal rotation and adduction of the leg as you move. It is only when these elements are deemed to be excessive that they should be corrected.
How do you retrain movement patterns?
You start by practicing them in very stable, easy positions. For example, by controlling your legs properly while you do a double leg squat, keeping the knees in line with the middle of your feet.
Once you master the easy ones, you can go more dynamic, e.g. lunges. You should control all three elements (pelvis, leg, foot) while moving in and out of the lunge position.
If you’re a runner or jumper, you should also include exercises that challenge your control and movement patterns under fast and explosive conditions, e.g. during hopping or jumping. But please make sure that you build up to these exercises by following a comprehensive strength training plan first and only add them into the final stages of your rehab. If you add them early on, you can really make your IT band flare up.
Box jumps
These should only be added into the final stage of rehab. Start with a low box and progress to higher ones.
Instructions:
Stand in front of a low box.
Hop onto the box with both feet simultaneously.
Make sure that when you land, your knees stay in line with the middle of your feet.
Then jump back down, again checking your landing mechanics.
Do 10 times (up and down).
Rest 3 minutes.
Do 2 sets in total.
Running technique drills
The last piece in the rehab puzzle is to ensure that all the good work you’ve done with your exercises is actually transferred into your running form. The best way to do this is through specific running drills or cues. We’ve dedicated a whole blog post to running tips and drills for coming back from IT band syndrome.
How we can help
Need more help with your injury? You’re welcome to consult one of the team at SIP online via video call for an assessment of your injury and a tailored treatment plan.
We're all UK Chartered Physiotherapists with Master’s Degrees related to Sports & Exercise Medicine. But at Sports Injury Physio we don't just value qualifications; all of us also have a wealth of experience working with athletes across a broad variety of sports, ranging from recreationally active people to professional athletes. You can meet the team here.
About the Author
Maryke Louw is a chartered physiotherapist with more than 15 years' experience and a Master’s Degree in Sports Injury Management. Follow her on LinkedIn and ResearchGate.
