How to Treat Injuries Like an Elite: Healing ITBS in Five Days

by Jason Fitzgerald

Two weeks ago, I set out to run 11 miles with a few 30 second sprints near the end in my old Nike XC spikes. It was supposed to be a standard distance run with some turnover work, but it ended badly with tightness in my IT band at the knee insertion.

Luckily, I took some very proactive steps to aggressively treat the problem and I want to explain how to treat injuries so you can limit their impact on your training.

How to Treat Injuries - IT Band

After I ran 67 minutes, I changed into my old spikes (which didn’t have any spikes screwed in) and ran 4×30 seconds hard with a 45 second walking recovery. I noticed a few things as I was doing this workout:

  1. The spikes were very stiff and I had a hard time running comfortably in them.
  2. Being stiff, running very fast on asphalt was a bad idea. It felt like I was stomping my feet against the pavement.
  3. I was doing these surges in a parking lot near my apartment which isn’t completely flat. Half of the surges were slightly downhill and I was pushing it too fast. My form was suffering and in hindsight, I should have went slower on a level surface.

As I was finishing my ten minute warm-down, I could feel the outside of my left knee start to get tight where the IT band inserts. I finished the ten minutes, did some core, and hoped a good night’s sleep would take care of the tightness. It didn’t – the next day I barely finished my morning run and I knew my IT band was in trouble. This is the same issue I dealt with after the NY Marathon in 2008.

Aggressive Injury Treatment

Elite athletes are known for aggressively treating injuries so they can maintain their fitness and resume training as quickly as possible. I’m not claiming to be elite, but I modeled my treatment plan on a professional who needs to be back running as soon as possible. Here are the action steps I took to be able to run again:

Stop Running. Running was causing pain on the outside of my knee, so I took Wednesday – Sunday off with no running. It’s simple – if it hurts to run, don’t run.

Increase Strength. Knowing that my IT issues stem from a weakness in my left glute and hip area, I took extra time to strengthen that area. I expanded my ITB Rehab Routine to include more pistol squats and more repetitions.

I also did a lot of core workouts even though they do not directly impact my IT band. With five days of no running, I had time to focus on core strength. Staying on top of the little things is important.

Massage the Injured Area. This may or may not be appropriate for your specific situation, but in my case it helped a lot. I used a foam roller and a tennis ball to work out tightness in my quad, IT band, glute, hamstring, and hip. I also stretched after using the foam roller and tennis ball. I don’t think it does a lot, but it did make me feel better. I own “The Stick” but I find the foam roller to do a better job for self-massage purposes.

Sleep More. Most recovery and healing happens when you’re asleep, so I made sure to get a lot of sleep. I usually sleep for 7-8 hours, but during periods of heavy training or if something is especially sore, I try to increase that to 8-9 hours.

A more detailed version of this treatment protocol is included in the Injury Prevention for Runners program.

Lessons Learned from Being “Almost Injured”

I don’t really consider this a major injury since I took only five days off and am now back running strong. But there are very important lessons I learned from this experience that I hope will help you too.

First, realize when your body is fatigued. It’s important to run when you’re tired sometimes so you can get better, but I was doing too much: running in unfamiliar shoes while I was tired, downhill on pavement, at nearly 100% of my maximum speed. In hindsight, that’s a recipe for disaster. I was not being smart.

Try to have foresight instead of hindsight. Looking back, I know that I was making a poor decision. But at the time I thought I was Wolverine and couldn’t get hurt. We’re all human, so recognize when to back off and run easier.

Keep up with your strength exercises. Admittedly, I wasn’t doing as much strength work as I should have been and this probably put me at a higher risk for tweaking my IT band. My left IT band is always problematic, so I realize that I have to be diligent in taking care of it.

It’s helpful for me to have “routines” that are 10-15 minutes long and consist of 15-20 different exercises. When I say I’m going to do my “standard core routine,” I know that I won’t do just a few exercises and quit.

Strength exercises are the cornerstone of injury prevention along with smart training decisions. I had been slacking off in both regards and I lost 5 days of training and had a week of lower volume. Running is cumulative, so the best thing you can do for your long-term progress is stay consistent.

The one thing I wish I had done during my time off was cross-training. In addition to helping maintain fitness, it probably would have made my recovery easier. By circulating blood without hurting it, the injured area of my leg can heal faster. Next time, I will try to bike or pool run. Luckily I own a road bike, but finding a pool that has AquaJoggers is difficult.

After my five day “holiday” I ran a 50 mile week, which is about 30% less volume than I was doing before my ITB problems. I’m happy to report that with consistent strength exercises, use of my foam roller and tennis ball, and running slow when I need it, that I’m healthy and back running.

For a step-by-step treatment protocol for ITBS (including the top myths about treating the injury), check out Injury Prevention for Runners.

If you always forget the exercises to the ITB Rehab Routine, get an illustrated guide (free) by joining now:

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Robin

I had to quit running for a while due to severe pain in my feet that even the podiatrist called and treated as plantas fascitis…………well, it was just really bad IT and Periformis issues. Treated both aggressively with the foam rollers and tennis balls and got me back to running!

Rick

Hi check out this great resourse centre for self treating injury problems;
http://www.athletestreatingathletes.com/

David Csonka

I think the hardest part will be getting people to follow the first bit of advice: “Stop Running.”

Greg Strosaker

Fitz, sounds like you were very proactive in managing the ITBS, I was amazed how quickly you were back to form on Dailymile – now I know why. Thanks for sharing, definitely worth keeping your post handy if my IT band ever acts up on me.

Fitz

Thanks Greg – I’m a big believer in really proactive, aggressive injury treatment. While I took 5 days of no running, I was catching up on sleep and doing a lot of strength/mobility work. I think the biggest thing was digging into the area with a tennis ball. It’s pure hell, but it worked like a charm!

Misti Pandolfo

I believe I am dealing with an IT issue, it is affecting my right knee. It first flared Oct. 23 i believe because I changed shoes on my 19 mile run (training for my first marathon) – I was registered for my first half marathon Sunday Halloween. My knee/IT didn’t rear it’s ugly head until about 10.5 miles into race – then it was a quick walk and hobble over finish.
My GOAL is Disney Marathon for which I have been training 6 months for. Is this attainable? I am ahead of my training but am afraid to lose mileage by then. I decided to take 2 weeks off and incorporate foam roller, stretches and cross training. Just looking for opinions :)
Thank you!

Fitz

Hi Misti – that’s a good question. I’m not sure if you’re ready and would have to look at your past training for the last 2-3 months to see and advise on your next steps. I believe the Disney Marathon is in about two months, which is pushing it. Since you couldn’t finish a half-marathon, I’d be concerned that you can’t finish a full marathon. Try the ITB Rehab Routine I developed here: http://strengthrunning.com/2010/05/elite-core-and-dynamic-warm-ups-a-comprehensive-guide/. I also do online coaching if you’re interested :)

Sues

Hi there, about a week ago I fell awkwardly while playing basketball and the doctor said I must of sprained my ligament in my knee and I feel as if my knee if very week and like my knee shifts very easily. Now the doctor said my bones are good nothing is out of place but why am I feeling that way? Also would I be able to play next weekend for my basketball tournament ? I’m just unsure how to treat it other then not running alot ..

Beth

I have some persistent tendonintis in my posterior tib. I’ve tried rest, ice, stretching, streghtening, orthotics, etc. Although it’s not as bad as it once was, it’s still there. I’m wondering if this is something I’m just always going to have to deal with as a runner.

Fitz

Sorry to hear about this Beth. Maybe it’s something that we can work on together. Feel free to email me at support@strengthrunning.com and we can chat to see if it’s a good fit.

Cheers,
– Fitz.

Dan

Hey Fitz, I’m a Senior in highschool and a newcomer to this site (just googled IT Band injury and your post about your 6 month injury popped up) and I want to say how remarkably helpful this has been. I injured my IT band 4 months ago through what i think was a combination of playing frisbee barefoot and my substantial over-pronation. I had been running about 40 miles a week with Track too, so I could have been doing something wrong there too. Regardless, I couldn’t figure out what was wrong due to the placement (sometimes the back of the knee, sonetimes the side or front) and persistence of the pain, and I wasn’t able to run at all on it. After seeing 5 or 6 doctors and trainers about it and hearing everything from torn ligaments to the doctor telling my parents I must be faking because he couldn’t find anything wrong with me and I couldn’t pinpoint the pain source, I finally saw my school’s trainer last night. Within 30 seconds and a few painful pokes to the outside of my knee, he had me diagnosed and gave me some stretches for it.
My problem now is that after using probably a little too much Advil to hobble my way through soccer preseason these past two weeks, I feel my injury is too severe to be cured by merely some stretching and icing over the weekend like he claims it will be. Do you have any additional treatment ideas that could get me back in action relatively quickly? I’m sure you know how frustrating it is to be nagged by this kind of injury, any help you could give me would be extremely helpful. Thank you for your time and awesome site,
Dan

Fitz

Hey Dan, thanks for stopping by. First things first: stop running! It sounds like your pain is pretty severe so when you keep running on it you’re just making it worse. ITBS is a bitch so you can’t predict when you’ll be back, but you should rest right now. Have you done any rehabilitative strength exercises? Try my ITB Rehab Routine (video here: http://strengthrunning.com/2011/02/the-itb-rehab-routine-video-demonstration/). I’d start with doing it every other day and using a foam roller daily to massage your glutes, hamstrings, quads, and hips. Start with that and remember to always keep your coach informed of what you’re doing. He may have other suggestions too. Good luck man!

Monique

My IT BAND issues started after doing Columbus half marathon OCT 2011. Well actually about a week after. Didnt recover from the race and keep training hard for a 10 mile which was two weeks after. Question I have, when having IT BAND issues, do you find your knee clicking? When i am in a sitting position and raise my leg straight…. it tend to click or snap. Sometime when I am turning quick from a standing position too. I also find that i cannot squat. And if I do squat … i have a hard time getting back up! hurts. Feels like there is tightness right above the knee cap toward the outside of the knee. (almost the quad area). I’ve been so frustrated. Seems like I was running the best I have in years before this happened. I just viewed your exercises and tried a couple and gonna start doing the every other day.

Jason

Hi Monique, thanks for your comment. My left knee (the leg I had ITBS on) still clicks but it’s not painful and only happens when I bend the leg around parallel to the floor. This routine should be a great first step to getting you healthy. Stay consistent with it!

Kurt

I hope this isn’t too late to ask, but I wanted to ask about this. I first injured my IT band during a marathon – it was raining, shoes were wet, and I lacked the hip strength/flexibility that is necessary. I have been continuing to run since then and training for a 2nd marathon. I get an aching knee pain if I run for longer than 2-3 miles. The pain isn’t out of control and I can run through it.

My concern now is that I am going to make it worse to where I really lose some training time. In hindsight, the 2nd marathon isn’t the best idea (13 weeks of separation between events and 6 weeks from now).

I have been doing your ITBS workout for about a month. I am thinking about taking a week off to let this thing heal some, potentially completely.

My question is this: how much is training affected by taking a week off? I am not an elite runner, but I was putting in 35-45 mile weeks lately and was about to jump up to 45-50 mi/wk in the next week or so. I

Next question: if I can run 1-mile pain free, should I keep running 1-mile per day to keep somewhat active? Or am I better off resting completely?

Thanks again for this site! It has been incredibly helpful.

Jason

Hey Kurt – not too late :) A week off won’t do much to impact your aerobic fitness. That starts to decline after about 10 days or so. But it will erode your structural fitness – or your body’s ability to withstand the impact of running (bones, tendons, ligaments, muscles). My advice is to take the week off and focus on the strength and mobility work you need to get healthy. Running is exacerbating the injury – so stop briefly. Good luck healing! I’m coming out with something quite comprehensive about this in a few months – if you’re interested jump on my newsletter for more: http://strengthrunning.com/newsletter.

Kurt Stein

The knee didn’t heal up over the week off! I will keep doing your IT/hip routine and continue to work on my form. Things don’t bother me as much when I am in my Vibram FiveFingers or running barefoot.

Thanks for the great website and excellent information.

Aron

Thank you, thank you, thank you!

I’ve suffered from recurring ITBS for years, often having to sit out weeks or months of training (and miss or suffer through races!) because of it. I had my first flare-up in a while last week after a long run (probably too much distance for so early in the season), so I was desperate to find a routine that could quickly build the strength I need and heal the injury to be rid of this forever. I followed the advice in this article and incorporated your suggested warm-up, core, ITB Rehab, and strength routines diligently everyday with no running and plenty of the foam roller. Five days later, I just went for a (shorter) long run, completely pain-free! I’ve never healed this quickly before and I know I now have a long-term plan that will get rid of this nuisance injury forever.

Thanks again!

Jason

Hey Aron, wow that is awesome! So glad that it worked for you :)

Jenn

I also have been dealing with IT band tightness, pain on outside of left knee as well as a nagging pain just under left glute. Overall, my left leg from hip to shin feels tweaked. Can’t figure out where it’s all coming from. I have been doing single leg strength exercises, foam rolling and stretching, but nothing seems to be completely curing it. Any sugestions, other than going to PT?

Jason Fitzgerald

Hard to say if you don’t know where the pain’s coming from. Try the ITB Rehab Routine which has helped a lot of runners with ITBS. Also highly recommended is the Standard Core Routine!

Angela

this is great information. I was diagnosed with ITBS in July. I stopped running and focused on crosstraining. I never went back to running and instead have stuck with crosstraining (sort of like crossfit but not) and the ITBS went away. It seems my ITBS is back in my left knee and starting in my right, which is alarming considering I am no longer running. Going down the stairs is the worst. I am on the foam roller and icing as well as modifying my workouts to avoid aggravating the injury further. It is worst now than when i was running. The IT band is so tight/ inflamed that it hurts to lightly press my fingers on it.

My question is this: will yoga help me overcome this? my trainer told me that i have alignment issues that yoga will correct as well as weakness in my hips (and i think other areas of my legs). A PT I saw in july told me to roll it out, the trainer says rolling will not correct the problems causing the ITBS. He also said no running, lunges, squats, crawls, or any dynamic movement of my knee for a month. seems like jail. and i hate yoga- but i will do anything to beat ITBS. thoughts?

Casey

I am desperately looking for tips to overcome my ITBS. The problem started after I (stupidly) decided to run 10 days after shoulder surgery with my arm still in the sling. I think the 10 days off, coupled with the lack of stretching, and altered body mechanics severely injured my IT band. The next day I could not run and it hurt to walk for weeks. It has now been a month since the injury and I am desperate to get back to running. I have a few questions regarding the article:

My PT has me running on it occasionally to increase blood flow. At this point I can make it a couple of miles, but it usually inflames afterwards. We are working on ways to reduce the post-run inflammation. In your opinion, is the running helping or hurting?

The pain used to hurt most walking up or down stairs. Over the weeks this has lessened significantly, but it now hurts much more to the touch than it used to. Should I be concerned about that?

Assuming I can get the injury under control, how aggressively can I return to running without risking further injury? I was doing 50-60 miles a week prior to the injury. How soon should I return to that level of volume?

I would appreciate any advice I can get.

Jason Fitzgerald

Hi Casey, shoot me an email and let’s chat. I have a few ideas.

Jen

Great article…exactly what I needed today as my left leg as well is problematic for my IT band. I ran too much this weekend and thought I was superwoman. Using foam roller already and plan to take a few day off from running. Training for a half and do not want this to keep me from going the distance!

James

Thanks for wonderful tips you’ve laid out for faster recovery when suffered from injuries. I”ll keep them in mind.

Kym

This is really good information you have here! I am in high school and play basketball. I got this injury about a week and half ago but have been continuing to play through it, until about 3 days ago, when I starting resting it completely. I have this important college prospects camp that I need to be ready for in 6 days. I saw what you did for recovery. I want to follow the ITB Rehab Routine and the steps you have outlined.

Should I be working out on a stationary bike and/or swimming over the next few days? Is there anything else I should be doing? When you started back running after 5 days, did you feel pain? I just don’t want to miss out on my opportunity!

Thanks!

Justin Nixon

Just to say this is the second time I have had itbs and the second time I have followed your advice with some slight modifications I.e. I was already doing more reps for pistols using the rehab routine. This time I healed in 5 days which was was way quicker than last time. Time to keep up with the glute strength and smarter running for me so it doesn’t happen again, thanks. P.s. what trainers (if any) would you recommended for running 5-10k to help prevent problems like this would you go minimalist as I had a structured instep before was this part of the problem? Thanks again.

Justin Nixon

You should be ok Kym, foam roll before and after and make sure you do the routine at least twice. On the other days light bike or swim :) good luck

Jamie

Hi Jason,

I just checked out your ITBS workout video and it’s awesome. Right now I don’t have a thera-band, but want to get one. When I click on the Amazon link you provide, I see a red, flat 6-ft band. Is this the exact one you like to use and if so, what diameter do you tie/loop it to?

Any other links to good alternatives?

Thank you!

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