The iliotibial band is a fascia that runs down the length of the outer thigh from hip to knee. The repetitive action of running can put a large amount of stress on it, causing it to tighten and shorten after runs that are longer than half an hour or so. This in turn can cause fiery pain in both the outer side of the knee and up in the hip. It starts off as mild discomfort and ends up causing agony, leaving you in despair of ever running again and tackling staircases tearfully in reverse. It is a genuine torment for many runners, as it’s impossible to tell whether it has gone until you have been running a while. It tends to make its reappearance when you’re tired, possibly being rained on, a few miles from home, and feeling rather low. Like a bastard ex-boyfriend who sends you a flirty text every time you think you might be moving on.
While ITB pain is common, it is not insurmountable, and there is a lot that can be done to alleviate or prevent it. An excellent solution in the short term: Buy a foam roller (a large foam rolling pin–type object that looks not dissimilar to a buoyancy aid or a prop from Gladiators) and lie on your side massaging the fascia while you watch TV. While initially painful, this activity does a great job of relieving tension in the ITB and can be a huge help with the pain. However, it does not solve the problem of what is causing the pain.
In the long term, it is important to work out why the iliotibial band is shortening. There can be many reasons. The most common is because the gluteus medius muscle on the outer buttock is not strong enough or working hard enough. This muscle is the one you can see—the outer muscle lying on top of the others, or as I call it, “the Kardashian muscle.” It is this one that turns the leg outward. In many of us, the leg may be inclined to turn inward, collapsing the arch and making the foot flatter, which is called “pronating.” This lack of proper foot control as the foot hits the ground (which many fancy running shoes claim to eradicate entirely) lets the knees roll inward, creating tension on the ITB. This is generally a result of an underdeveloped gluteus medius and can be helped enormously by activating and strengthening the muscle.
You can investigate further, asking why your gluteus medius isn’t strong enough. The answer will relate to the fact that instead of spending our days clambering over fields picking berries and chasing animals for dinner, we watch telly and wang around on the Internet. Bits of our bodies are unused like never before, so when we challenge them, our muscles are, quite reasonably, a little startled—at least at the outset.
While there are a lot of exercises online, as well as hundreds of “helpful” YouTube videos (which I suspect are more often watched by curious fourteen-year-old boys with a developing taste for physiotherapists in Lycra), it is always worth finding a professional who can look at exactly which muscles need to be reactivated and how. I am of the opinion that investing in a decent physical therapist and spending an hour working out specifics with them is a far better use of time and effort than trying on numerous pairs of running shoes and bleating to your loved ones about how your new hobby hurts. Doing a few (admittedly boring) exercises can generally do a much better job of solving the problem than spending hundreds of dollars on the right corrective running shoe or orthotic insert. Save your money for getting someone attractive to talk to you reassuringly while rubbing your thighs, and then buy a running top you feel a bit sexier in. Everyone’s happier this way.