Shin Splints: What Runners Get Wrong About Recovery
My Story of Being a Runner With a Torn Hip Labrum
Plantar Fasciitis in Runners: Why It Keeps Coming Back
IT Band Syndrome: Facts Behind the Myth of this Common Running Injury
IT Band Syndrome: Why “Tight” Isn’t the Whole Story
If you're a runner, chances are you've either dealt with IT band syndrome (ITBS) or know someone who has. It's one of the most common overuse injuries in runners, showing up as a sharp or burning pain on the outside of the knee — often appearing like a few miles into a run, and flaring with downhill more than uphill.
What Is the IT Band, Really?
The iliotibial (IT) band is a thick, fibrous band of connective tissue that runs from the hip down the outside of the thigh to just below the knee. It connects with the glute max and the tensor fasciae latae (TFL) at the hip. Despite popular belief, the IT band itself isn't a muscle — it can't be “stretched” or “loosened” the way a muscle can. It's dense, strong, and largely non-contractile and it is considered to act like a tendon that absorbs impact for landing and push off during running.
So What's Actually Causing the Pain?
For years, ITBS was explained as simple friction — the band rubbing back and forth over a bony bump at the knee (the lateral femoral epicondyle) as the knee bends and straightens. That's part of the picture, but more recent research describes what really elicits pain is the IT Band compressing, or “pinching”, the underlying fat between itself and the knee. This area is highly innervated with nerve endings and can also result in inflammation.
Several factors can contribute to IT Band Syndrome.
1)Mechanics: When the hip isn't stable, the knee tends to drift inward with each stride. That subtle collapse changes the angle at which the IT band crosses the knee, increasing compression and irritation at that same spot each step. Runners take approximately 1600 steps pre mile.
2) Training Errors: A sudden jump in mileage, too much downhill running, or worn-out shoes, and you've got a recipe for ITBS.
3)Terrain: Running narrow trails creates tension at the IT Band due to the feet having to land close together (called a narrow step width) and creating a sharper hip angle. Also trail running entails a lot of long and steeper downhill terrain which greatly increases loads at the IT Band
4)Fun Fact: According to current research, weak hips are not correlated as a cause of IT Band Syndrome, but hip strengthening is supported in the research as an essential part of getting better.
Why Foam Rolling Isn't the Fix
This is a big one: research using shear wave elastography has found no meaningful difference in IT band stiffness between injured and healthy runners. In other words, “tightness” in the band itself doesn't appear to be the real problem — so aggressively foam rolling it usually doesn't solve anything. Some runners find rolling the surrounding muscles (like the TFL and vastus lateralis) helpful for comfort, but it's not addressing the actual cause.
What Actually Helps
1. Build hip stability. Glute medius and glute max strengthening (think side planks, clamshells, single-leg bridges, and single-leg squats) is the cornerstone of treatment.
2. Look at your form. A physical therapist who works with runners can assess your gait for issues like overstriding, low cadence, or excessive hip drop — all of which load the IT band unevenly.
3. Manage your training load. Sudden increases in mileage or hill work are common triggers. A general rule: don't increase weekly mileage by more than about 10%.
4. Address it early. ITBS tends to respond well to treatment when caught early, but can become stubborn and recurring if runners keep pushing through pain.
5. Get a proper evaluation. Because ITBS often stems from biomechanics rather than the band itself, a runner-specific PT assessment can identify why it's happening for you individually — not just treat the symptom. Also a gradual tendon loading and strength progression is essential for returning successfully in the long run. Always remember there are “differential diagnosis” possibilities, and lateral knee pain does not always mean IT Band. Diagnosing pain accurately is the MOST important step.
The Bottom Line
IT band syndrome isn't really about a “tight band.” It's usually a signal that something upstream — most often running mechanics, muscular stability, or training errors — needs attention. The good news: with the right strengthening and gait adjustments, most runners with ITBS get back to pain-free miles.
How to Handle the "Uptick" in the Tick Situation- Advice from an Expert
So… this month I am taking a brief departure from the world of running medicine to share information I was curious about. This summer on the trails I encountered more ticks than any other summer I could remember. As a trail runner, ticks have always been a concern due to the risk of Lyme disease, but I seemed to encounter them infrequently. This summer has really been different and I had a conversation with a friend who also noticed this trend.
This is my conversation with Carriedelle Wilson Fusco, MSN, FNP-BC, who currently works at MAHEC. Cariedelle was kind enough to take the time to share this information in my newsletter. I hope this helps all of you outdoor enthusiasts to stay healthy!
3 Best Form Tips for Trail Running
Trail running calls to many runners for different reasons! It can be the quiet of the surroundings, the exploration of new places, the softness of the dirt, or the fun of never having to stop for a street light. Some runners are drawn to the trails because they feel it is “easier” on their bodies than the road. There is some truth to this in that runners tend to take shorter and more varied steps on trails, which does decease impact. Trails offer many benefits, but sometimes keeping in mind a few form tips keeps runners happy and healthy for the long run.
1) Pick up those feet!
One of the exciting features of trails is the many rocks and roots that speckle the trail. Our feet must be able to react to these changes. No matter the pace, being agile will decrease risk of falls and sprained ankles. Here are a few fun warmups!!!
Jump rope: 1 min intervals in place for 3-5 sets, focus on clearing the ground and pulling those knees up rapidly. The ropes rhythm forces a more elastic cadence with our feet!
Box jumps: these are great whether you have access to jump boxes at the gym or just use a curb or stair step. For 10-20 reps practice bounding with both feet clearing the ground, pulling knees up toward your chest, to land with feet entirely on the box or curb. START SMALL and try to repeat in smooth jumps on and off the step , work up to 30-45 seconds of bounding back and forth, 3-5 sets. Use step heights that feel easy and work your way up!
2) Running Uphill: Tall Lean for the Glutes!
Efficient form: LEANING FORWARD FROM THE ANKLES AND PUSHING “TALL” THROUGH THE GLUTES Running with a proper forward lean is having the body stacked in a straight line with a gentle lean from the ankles as they push off. This allows most of the weight of a runner to be positioned in front of their foot strike to allow ease with forward motion. A lean INTO a hill helps move the body forward with the least amount of work. YOU MUST BE SURE TO STRENGTHEN YOUR HIPS TO GET THE JOB DONE (maybe another article (: ****Self cue: practice squeezing your glute muscles (buttock muscles) with each leg during the “push” up the hill. This will straighten your hips up and forward to get you to the top. Also this will make you stronger with longer and steeper climbs!
3) Running downhill: Lean Into the Hill
Descending a hill or a long run downhill sounds easy, but many have experienced the sore quadriceps and high rates of knee pain with this kind of terrain. Downhill naturally involves more impact because the ground is sloped away from us, and we land with a more straightened knee. We can mitigate this impact with a subtle change of posture.
Poor form: LEANING AWAY FROM THE HILL AND “BRAKING” WITH YOUR HEELS It seems natural to lean back when you run downhill, but this will actually increase impact and risk for knee pain and heel pain.
Efficient form: SLIGHT LEAN FORWARD DOWNHILL AND CYCLING THE FEET IN QUICK SMALL STEPS. I tell people this usually will feel like a “plank” and your abdominals will automatically tighten with this technique. The lean will match the downhill profile, a small lean for gentle downhill and a greater one (considering your ability to stay in control and move your feet fast enough) with larger hills. Practice on easy downhills or road. This is also a great drill to improve foot turn-over in general. This will feel less stiff and therefore less impact on the knees.
***Self cue: place finger on your chest and slightly lean into it. Try to keep light pressure on your finger as you hold your downhill lean.
I hope these quick tips help! If you have any questions about this article or would like more information on running form, feel free to check out my Video Library page or email me at runnersmechanic@gmail.com.
Uphill Drills and Strengthening
Warm Up
Wand Squats (Heels on the Floor) 8-12 rep
Wand Split Lunges (Tall posture with Flat Back) 8-12 rep
Agility Ladder 8-12 rungs
Forward step and Side step 4 laps
Single leg ankle hops : Forward and Side 2 laps (AmazonBasics Agility Ladder $12)
Activities
Power A Skip 10-20 m
2. Push Press 5 reps, 4 sets
**Remember to let knees flex quickly right before driving bar up and extending knees fully, “pops” the bar overhead
Box Jump 5 reps
6,8,12, or 24 in box or step
*Can start in a seated position for extra challenge to gluteals and quads
Focus on quick landing of both feet COMPLETELY planted on the box
(Can improvise with running stairs/bleaches and slow step down to return if at a track)
Bungee Single Leg Take Off with Step
Forward 30 sec 2 sets
Side 30 sec 2 sets
Med Ball Deep Squat Throw 5 times
Equipment
Agility Ladder:
(AMAZON): $11.95 REEHUT Agility Ladder w/Free User E-Book + Carry Bag - Speed Training Equipment for High Intensity Footwork (8 Rungs 12 Rungs 20 Rungs)
Sports Cord:
(AMAZON) $29.95 Scandinavian Sports Bungee Resistance Speed Band Set – 360° Rotation, 80 lbs Resistance Strength Bungee Cord 22ft Length, Sport Cones and Bonus Exercise Folder – Acceleration & Speed Training Tool
If you need a door anchor for the cord: (AMAZON $8.50) DYNAPRO Door Anchor- Made Extra Large to fit D-Handle Resistance Bands
Step:
AMAZON : Adjustable 6-8 in arobic step $35.99Best Choice Products 30in Height-Adjustable Aerobic Step Platfrom Exercise Accessory w/ 3 Levels, Non-Slip Surface
WalMart: $67 Buy-Hive Plyometric Jump Box Fitness Exercise Jumping Platform 12"/18"/24" Bounce Training
WalMart: $107 Sunny Health & Fitness No. 072 3-in-1 Foam Plyo Box Jump Training