Ready, set, go! This is episode 455 with Doctor of Physical Therapy, host of the Healthy Runner podcast, and certified running coach, Duane Scotty. Welcome to the Strength Running Podcast. I'm coach Jason Fitzgerald and I want to help you become a better runner. Don't miss StrengthRunning.com, our home base where you can find training programs, our award-winning content library, and our free email courses. Now I've been hard at work behind the scenes with our community, my coaching and training program clients, but also our entrepreneurship community at the Huddl. If you want more of me and define the group that can help you achieve your wildest goals, whether you're a runner or a business owner, I can help. Join our running team at StrengthRunning.com/join or apply to the Huddl at FindMyHuddl.com. I can't wait to work with you. I also couldn't do this podcast without the help of our partners. If you get value from the show, you can support us by supporting our sponsors. 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And by the way, keep sending in those testimonials. They fire me up. Today's guest is Dr. Dwayne Scotty, a physical therapist, a board-certified orthopedic clinical specialist, certified running coach and host of the Healthy Runner podcast. He's the founder of Spark Healthy Runner and after spending years in the gym, Dwayne finally decided to become a runner as an adult and immediately got hooked, you'd love to see it happen. Our conversation today is all about IT band syndrome. Unfortunately an injury that I am intimately aware of after having it several times, including once for six months. I personally saw four physical therapists and have then in turn helped hundreds of other runners prevent this injury. You may be aware of my ITV rehab routine, which is appropriate for all runners, but especially those with ITBS or a history of the injury. Don't miss the link in this episode's description to check out the routine. It only takes about 10 minutes. Without further delay, please enjoy this IT band syndrome masterclass with Dwayne Scotty. All right, here we go, Dwayne. Welcome back to the show. Thanks for having me back Jason. Always good to connect with you. Yeah, well, I always love hearing from you. You are not only a running coach, but a physical therapist. You bring both perspectives to your clients. We decided to record an episode today talking about the injury that has captured my heart, my arch nemesis, IT band syndrome. This is the injury that almost ended my running career actually. The process of me getting healthy from ITBS is what actually prompted me to start strength running way back in 2010. It's a little bit of a love-hate relationship. Thanks again. Yeah, and I love that that was the genesis for you starting what you have created because I'm sure we'll get into it today, but really the biggest way to fix this problem and prevent it from coming back is strength training. The fact that you had that foresight and really took you down that pathway, I just love and hopefully that will be the big takeaway from our conversation today is that strength training is going to be key in order to prevent this from coming back if you have had this in your running journey. Every time you try to increase mileage, increase speed, do too much downhill running or run on too much countryside roads. If this pain has always come back on the outside of your knee, then this is going to be informative for many area listeners. Yeah, oh man. We could spend 30 minutes unpacking all the little gems that you included in that one little minute of content right there, Dwayne. But, let's start kind of general. You've been treating runners for quite a while now. Is this one of the more common running injuries that you see in the clinic? Yeah, so you just call me old, so I'll note that. We were just joking about that before we hit record here. I got some years on Jason and my kids are a lot older. I got two girls who are older, so we were talking about that. But yeah, this is one of the common injuries that we see for anyone who really treats a lot of runners. This is the most common in those I find going for their first marathon and they really are looking to increase the distance and they're trying to train for their first marathon. Unfortunately, a lot of the runners that I see with this condition, they've signed up for that marathon, never got to the start line because at my 16-long run, my 18-long run, they got this sharp pain on the outside of their knee that just stopped them in their tracks and they had to shut it down. They went to the doctor and the doctor was like, you know, you just shouldn't be running right now. Maybe the marathon isn't for you. Maybe you're just too old to run marathons and hopefully like today we can provide some hope to your listeners is that that's not the case. You don't have to give up your marathon dreams or even half marathon dreams. But that is the most common runner that we see this problem in is when you're really trying to increase that distance and you're going for the half or you're going for the full and this kind of injury does creep up. Yeah, you know, my experience with IT band syndrome was when I was first introduced to college level, mileage levels and the difficulty of college workouts and then a more severe version of this exercise came about right after my first marathon.
So, you know, it's definitely at least from my personal experience and in my coaching experience, working with a lot of injured runners, it happens when you try to take your running to the next level. A lot more volume, a little bit more intensity, maybe the workouts get a lot, a lot more challenging. And, you know, you hinted at how you know if you have IT bands in your own, but how do you know if you have this injury? What are the warning signs? Yeah, so it is usually one of these types of injuries, unlike you and I had some really good conversations on your show before about Achilles tendon opathy and proximal hamstring tendon opathy, where those tendon type of injuries tend to, you know, kind of feel it at the beginning of a run, and then the tissue warms up, you feel better halfway through the run, maybe your pain comes back during your long runs, or when the run is finished an hour or two after the run, and then you're just feeling that pain, you know, the rest of the day, IT bands syndrome is one of those conditions that actually you usually feel fine at the beginning of your run, and it just kind of hits you. At some point of your run, you get to certain mileage, and then you start feeling this, like literally like an ice pick on the outside of your knee, stabbing pain, and it is one of those things that can stop you in your tracks, and it does kind of like mess with your mind, because it can be kind of sharp, and it can, you know, be very painful. A lot of my athletes, you know, describe, and it can linger after that, or if you're working, you know, at a desk job, you know, after your run, you're sitting for a while, you go to get up, and it's like, oh, whoa, there it is, or you go down the stairs, you know, in the morning, and then boom, there it is. It's very localized on the outside of your thigh, and the IT band, just so kind of everyone's aware here, is, it's a connective tissue, right? It goes down the outside of your thigh, it is not a muscle, it's not contractile tissue, so it does not contract, and it connects to your TFL muscle at the top of your hip, which is a small little muscle, tensor fascia lota, no, you cannot order that at Starbucks, right? But you have this connective tissue that goes down the outside of your thigh, and then it connects to your shin bone, your tibia on the outside, and then it also has connections that go to the knee cap, and your patella can affect tracking of the knee cap, but you get localized pain on the outside of your knee, and that's how you know it's IT band syndrome, and it's not like the classic kind of runners knee or patella femoral pain syndrome, where it's kind of generalized in the front of the knee cap area, that's different pain that runners can get, this one is like pinpoint specific, you can literally put your finger on it, or your thumb, thumbprint, like it's not any bigger than that, that is where your pain is, is very localized, and it is increased with the longer that you run, and that's why we do tend to see it kind of come on, like I said, so this first time marathoners, or you know marathoners are looking like up their game, and they've really increased their volume, they've really increased their speed sessions that they're doing for this training cycle, and then they start to feel it on those long runs. Yeah, and you mentioned earlier how going downstairs can be one of those trigger moments for experiencing some of this pain if you have this injury, any kind of downhill walking, going downstairs, downhill running in particular, all of these things are probably going to exacerbate your IT band syndrome. I was wondering if you know why, because the opposite is also true, let's say running downhill bothers your IT band syndrome, if you go on a treadmill and you put it at like a two or three percent incline, you might actually be able to get through that run without any pain. And I'd love to know some of the mechanistic reasons of like what's going on here that makes downhill running a huge potential source of pain, while uphill running is actually a way in which you can build some capacity as you're getting healthy from IT band syndrome. Yeah, and it is really primarily because we're increasing the moment at the knee as opposed to the hip. So when we are running downhill, then we're changing forces. The knee is coming over the tibia, over the foot and ankle, when we are landing. The other reason that many, you know, novice runners can get pain with downhill running is their running form and they are overstriving when they're running downhill and they're not increasing their turnover time and their cadence. So it's like these breaking forces that are happening with every single step and the structure that is going to get stressed with that is really that IT band on, you know, the bottom of essentially, you know, below the knee. So it's really like increasing our breaking forces at the knee versus at the hip versus when we're running uphill, if you think about when you're running uphill, it's really hard to run uphill if you're like leaning backwards, right? So what do we do? We lean into the hill. We kind of bend from our hips a little bit. We use our glutes more. So we transfer forces more to the kind of the hip area and your hip muscles are contracting as opposed to the knee muscles when you're running downhill. Yeah. So definitely want to avoid some steep downhills, even long grades that might be fairly shallow. But if it's a very long distance at a shallow grade, it could exacerbate that ITBS. I think one of the other things that really sets this injury apart from other injuries is the sharpness of the pain. You know, you described it as an ice pick and it's true. It can be really jarring, unsettling, almost debilitating with how painful it is. Can you run through that or are you doing additional damage? Is that a big no-no? Yeah, great question. And it really comes down to kind of what is the irritability of the tissue in terms of like to run or not to run, right? So if someone is getting this sharp pain and it's intermittent only last for a couple of seconds, like that can be enough to like freak people out on a run. They feel like this ice pick in the side of their knee and they say it's like, you know, the pain scale is one way to measure this if we're doing zero to 10. And if they say it's like an eight, then it's like, yeah, that's pretty darn severe pain. But if they tell me during their run, they felt it and only lasted like five seconds and then it went away, then, you know, that's kind of proceed, proceed forward. You know, green means go, we're going to continue, you know, our training, our running, we're going to be mindful of this pain that you experienced. We're going to think about what strategies we can do to help alleviate and prevent this from happening. But it doesn't mean you need to stop running, right? So if let's say, you know, you're feeling just a little bit and you're having a little more eaky, it's not even as sharp sometimes I'll have athletes that describe it like a two or three at a 10-pin wise. If when you stop running, pain goes away, that's still safe to run. And this is the biggest, I think, you know, this is really why I'm passionate about what I do today, you know, going from kind of teaching future physical therapists of how to like treat patients with IT band syndrome to like working with the running community now full time in how to kind of manage these injuries that you don't need to stop doing the thing that you love, getting in your mental clearing miles. And we all know the benefits that running affords us, right? Like physically, mentally, and, you know, the old way of thinking 25, I talked about my age before when I was in PT school 25 years ago, was like, hey, you have pain, pain means no, you don't run. Like stop running, we're going to do PT, you're going to get fixed for six to eight weeks, three times a week. And then when you're pain free, you're discharged. Like, congratulations, graduation. And then good luck, go ahead and run. And we know that that really doesn't work because a lot of people, they stop running so long, they get back into running, and then their pain just returns again. So this can actually be fixed with maintaining running volume, right? You might need to modify your running and your training, depending upon how irritable the tissue is, but it is literally super rare. I can count literally on one hand, Jason, and like, the 23 years that I've been doing this, that I've ever had a runner stop running for more than literally two days. So like, that's what I'm talking about. If someone's just really irritable, and it is that eight out of 10 pain, and it's lingered hours after the run, then yes, like, we need to calm this tissue down and, you know, take two days off, maybe three days, like, that's honestly the max, I would say that you would need to for this condition because this is not a injury that is going to cause long term damage. Like, you don't, like, I mentioned, it's a connective tissue. It's not part of the joint inside the joint. Like, let's just say you just ignored this and, you know, you didn't get it better and you had pain forever. It's not going to cause long term, like, joint damage. You're not going to get arthritis if you didn't, like, take care of your IT band syndrome. And, most importantly, you're not going to tear your IT band, since, like, your IT band off of the bone. It doesn't happen. It's not a thing, right? It's not like, it upweigh a hamstring tendon where, yes, that can tear eventually if you just, like, let it be there chronically forever. Or even you're a Achilles. We had talked about that on our last chat is, yeah, like, you're playing basketball, you take a quick move. If you've, like, ignored your Achilles pain for a good, you know, a couple of months or a year, like, that thing could tear your IT band. It doesn't tear. And the amount of force, and this is where I'm sure we'll get into at some point in terms of, like, treatment-wise, the amount of force they've done this in cadaver studies is you cannot actually stretch the IT band. It is. so strong and powerful. It's such a taught connective tissue. Like you cannot tear it. So it won't happen. I guess to answer your question is like, the worst case scenario, and that's what I really reassure like my runners who got that dream marathon on the count. They finally got into New York or Chicago, right? I've heard of the lottery or I see a lot of run Disney runners who are doing the dopey challenge. I've done it twice myself. And it's like, you know, 50th birthday, right? They sign up for the dopey challenge. It's like one of these things they want to conquer. And they wind up having this pain, but we're still able to get them to run that marathon in a modified way without any long term damage. So hopefully that kind of reassures your listeners that if they have this pain, I'm not saying they ignore it. Don't do anything. But just be reassured that it's not going to cause long term damage if, you know, you do have this pain or if you have that goal race that's been on the calendar, you paid all the money for the travel and all of that. And it's like, should you run it? Should you not run it? Like you can run it in a modified way so you can enjoy your experience and actually, you know, do that event that really means a lot to you. Yeah. Oh, do I wait? Let me just say thank you for soothing all of our collective anxiety a little bit that this is not the injury that's going to require surgery. We're not going to tear this thing. We can keep running through, you know, a little bit of pain with modified training. I think that's really encouraging to hear because it means that we don't necessarily have to put the goal race on hold. We can modify our training a little bit and still get there. Now, you basically said that the IT band syndrome is one of the thickest, toughest, tightest pieces of connective tissue in the human body. And I've heard almost every runner at some point say, my IT band feels tight. It sounds like the IT band should be tight. You know, I've heard it described as having the consistency of a truck tire. You're never really going to be able to stretch it because first of all, it's not designed to be stretched and if it could be more flexible, then it wouldn't be able to do its job in the first place. So can you talk a little bit about what it's supposed to be doing and why tightness is a good thing and we shouldn't even try to stretch it anyway? Yeah. And it is one of those things like evolutionary wise, I guess it is one of those structures that we have in order to actually walk on two likes. So it allows us to do that and it does help kind of stabilize support, our hip and our knee. And it is not something that you really want it to be loose, right? So it is going to be super taught. That's just, you know, the structure it is and the old, you know, line of thinking again, when I was back at PT school in those days is you'd have someone, you know, saying, oh, my IT band's tight, let me do this like stretch where you put yourself in this like ballet position, like fifth position, I used to be a dancer. So I kind of know some of the lingo, but you know, you put yourself in like this position and you try to like side bend in the opposite direction. No one ever feels that stretch to begin with. And like I always knew from the beginning, I was like this stretch, like even when I was going through PT school, I'm like, I don't know, I'm not sold on this stretch. Like I didn't give it to any of my patients when I was kind of working with, you know, folks as a novice physical therapist, but it is something that now we know and there's been a lot of literature within the last like 15 to 20 years since I graduated, that it is not a stretching issue and it's not a tightness issue that causes the pain. And it is really comes down to your mechanics as a runner that is causing your pain. And there's, you know, studies done on females and males, it could be a little different contributory factor, but it is a matter of fixing the movement patterns and strength deficits as opposed to like trying to stretch this structure out that you're not going to have any luck anyway, as we mentioned with stretching. So hopefully that answers your question. - Yeah, no, it definitely gives us a better idea of how to think properly about an injury like this. And before we get into some of the ways in which you treat this injury, I want to first talk about some of the things that runners do in training that may put themselves at a higher risk for this injury, or if they're trying to run through ITBS that may exacerbate the injury. And maybe I'll just start with giving one of my favorites, which is not really paying attention to the camber of the road. So maybe we can start with that one and go from there. - Yeah, I was actually just thinking about that on my run yesterday, Jason, as I knew we had this coming up because I do some of my runs on like a rails to trail. It's paved here, but there was one section of the whole this kind of like half mile that it is pretty cambered. And I'm like, it's kind of weird 'cause this is like a flat path, it's what's to me, but it's pretty darn cambered. And I think they did that for drainage purposes, but as I was running, I was thinking about that. And this is most common in those country roads, right? So if you live in more rural area and for drainage purposes, they do have the roads that are pretty cambered. It's angled in one direction, where it essentially creates one leg to be longer than the other. So you almost create this functional leg length discrepancy. And it can increase tension on the IT band, either on the longer leg side or even on the shorter leg side. So just having that ace symmetry with your running, and if you're always running like you should, toward traffic, we're always going in the same direction. And if that's all you're running on, then you are creating some of this asymmetrical kind of tension in your IT band when you are running. So that is definitely one that I know when I'm always kind of running on a camera. I don't like it personally, because I feel it. But if obviously, whenever I'm exploring and traveling from a girls' volleyball, and you don't really have a say, and the roads that you're running on, sometimes you have to deal with it. But if you are doing a lot of your training on those roads and you do have this condition, then it is a tool in the toolbox that you can really be mindful of, unfortunately, maybe having to drive to your site to go for your run, as opposed to just heading out the door in the morning. But yeah, the Canberra roads is definitely one that I find as a contributor, or some of the other training errors I see is, again, that first time marathoner who maybe gets sick, maybe has vacation, right? Has a work trip. And their schedule is just super busy. They couldn't get their long run in. So maybe they did, let's say 14 mileer, like the week before, they were supposed to do a 16, let's say, and they got sick, they missed that one, and then they just jumped to 18, right? So they went from literally, and they just liked their first marathon, they've never done an 18 mileer before. So they go from 14, one week to 18 the next week. That's something that I'll see commonly or just too much downhill, especially with all these downhill races, and maybe they might be a little less popular now with the penalty for Boston. But if you are training for a downhill race, where you're literally just running down a mountain, you're just doing too much too soon, right? And you're thinking, and I like your thought process, and like, hey, the demands for my race require me to do all downhill running. I need to train that way. I love that, but we're just adding in too much too soon. If you haven't been ready for downhill running, and you haven't built a base with downhill running, and you didn't strategically kind of sprinkle in downhill sections as part of easy runs, as part of long runs before you went and decided to do a full long run, like literally downhill the whole time, or do a speed session with this downhill angle. So those are kind of the common triggers that I see when someone will have IT band syndrome. Yeah, and I'll certainly echo that I think jumping up in an individual long run distance, adding a lot longer of a workout than you might be used to, not necessarily going a lot faster, but just adding another one, two, three miles worth of speed to a workout. Those in my experience coaching, those were probably the biggest contributors to IT band syndrome, because it's such a specific instance of increasing workload just too quickly. And then the other things are sort of the icing on the cake. Now it's spending too much time on a cambered road. And for me personally, it's interesting. If I run on the right side of the road, so I'm not facing traffic, my IT band will start to hurt within a mile. But I can run all day long on the left hand side of the road facing traffic, because my problem is on my left leg. And for whatever reason, that actually makes my left IT band feel better. And my right one is impervious to injury. And so I basically just stay healthy by over indexing on the left camber, which is weird, but is also a very self-aware thing for me now to understand about myself. Hey, just a short break for our partner Prevenex, the only supplement company that I trust. They've just released their new product, Muscle Health Plus. This is your anti-sourness supplement, a combination of creatine, branch chain, and essential amino acids, as well as ingredients to aid protein synthesis and absorption.
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I've seen a lot of coaches say that if they have a runner with a crossover gate, they're probably going to pay a little bit more attention to the risks of ITBS for this individual. Yeah, no, I'm glad they brought that up. There's been some correlational studies that look at folks with ITVAN syndrome and those that don't and those that have ITVAN syndrome do have this kind of narrow base of support. So when you're running and I literally just onboarded a new runner last night and she had this where it was almost like you said their legs are crossing over. So when you're analyzing, let's say they're running pattern from behind, you literally can't see the front leg because the other leg is blocking it and that's how narrow it's almost like running on a tight rope, right? Like their base of support is so narrow and what that does is that puts a lot of attention on the ITVAN because your femur bone is kind of angled inward at the knee and where this hit adducted posture and it causes more attention to the Iliotibio band. There's been some like case series that have looked at gate retraining for those folks and they did find a difference in terms of like pain levels for those that did the gate retraining where they really focused on trying to increase their step with just a little bit and a little bit goes a long way. I guess that's the thing I want to say is if you're listening to this and you're like, "Oh wow, I never thought about that." And you know what? I think I do have this crossover gate and I want to improve it. I've had runners go to like the extreme and they almost like running with their legs apart that just all you need is just a little bit and this one is tough sometimes to implement but if you have your own treadmill this works out really good to put a actually piece of tape down the middle of the treadmill and then you play the game don't step on the line and just to retrain your brain to take a little bit wider step with when you are running or down the straightaway of a track you could you know if you have access to a track then you know straightaway of a track straight line you can play the game of like one foot is on the line the other foot does not touch the line just to make sure you are getting a little bit of that separation and then that works out nicely too unlike the straightaway as you focus on it and then on the turns you know you're just kind of running normally and so it kind of gives your brain a little break that you're not having like focus on it the whole time when you are running but those are some things that I've played around with for those that have IT band syndrome and have that really narrow base of support where they almost have that like crossover kind of gate pattern. Yeah one cue that I've used that I find really helpful is just to imagine that there's like a golf ball in between your knees and so that gives your brain a little bit of a cue to keep some separation between your legs as you're running and again it's it's not like you're you're trying to run with two feet in between your two legs and you're all of a sudden spreading your legs really wide this is just enough just a little bit like you said that's all you need and you're probably going to cause more problems if you all of a sudden try to run with an extraordinarily wide stance when your body is used to that narrow stance. Now it gets to like probably one of the other big red flags is just a lack of strength training and in particular you know weak hips weak glutes is that something that you also see as a risk factor for ITBS? Absolutely and I guess to piggyback off of the last point you know having that narrow basis support with running the other and even more common thing that I see is excessive hip drop on the opposite side. So if someone's got IT band syndrome let's say on the left side I think you said you had then your hip is going to drop on the right side because the left outside hip muscles your gluteus medius muscle in particular really controls your pelvis when we're on one leg when we're running. So normal two to three drop is kind of normal but I've seen some excessive hip dropping going on and if you are just dropping that hip down when you are running every single step that creates that seam hip adducted posture we talked about with an narrow step with and puts excessive tension on the IT band. So really getting to number one trying to correct that from like a movement perspective and while you're running but then think about what's the cause of that and sometimes the cause of that is weakness of the glute max the glute medius on the outside maybe your deep hip external rotators those are like kind of like the three common hip stabilizer muscles we have and they're pretty much the three most important muscles I'm going to say that we have as runners to keep us healthy especially at the knees and at the hips obviously but it is something that I find very common is you know especially like this condition too is another common one that is just those people who don't strength train and they just run and they're not doing any strength training so I would say that's another common pattern I see is they haven't been strength training that's the great thing is that you don't need to do a ton of strength training work to actually get better from this condition it's just a matter of learning how to either activate gain an awareness of your outside hip muscles right with particular exercise like I have my kind of favorite activation exercises and have like a guide for IT band syndrome maybe that we can link in this training but just gaining that awareness of how to activate those muscles and then the key here is progression and how do we progress to the next level and we don't just stay on those activation exercise like you might have done clamshells right like it PT before and maybe you did like clamshells for like six weeks three times a week had a high schooler you were in the corner you're not even sure if you're doing it right but maybe you didn't get the proper progression but then a lot of times I see in the running community especially nowadays social media like it is getting more popular like runners are like hey I should be strength training probably because you're podcasts right they've been listening for years and they're like oh my goodness I'm not strength training I should be strength training but then we go to the opposite end of the spectrum where you know I see a lot of runners and it's like oh I have even new in strength training yeah I've been trying to fix this but I've been doing dead lifts and squats and I mean I heard I'm a female I should lift heavy so it's kind of like you have these movement deficits with running that are contributing to your pain and your IT vans syndrome and you think you're doing good by doing some strength training but maybe you're not doing the right strength training for what you need at that moment in time and not to say dead lifts and squats aren't great like program them for my runners but there's a time and a place for it and you might just need to kind of back down learn how to activate these muscles improve your movement patterns on one leg really getting good stability on one leg good control and because this condition is all about what we call like the frontal plane so it's kind of movements of either our feet going in our knees going in our knees going out or kind of our hip dropping in one direction so we need to actually improve the stability on one legs or our hip doesn't drop we have good trunk control our core is strong we have good like foot ankle activation and stability like all of that plays a role in taking tension off your IT band and then you get the progressions and then you can add load and you can kind of do things in that fashion I guess last point Jason as I'm thinking of it because I was kind of thinking back to our conversation we had last year about Achilles that was all about progressive loading and like increasing the weight and adding it in the backpack and like keep going up and up and up IT band syndrome we can't load that that tissue it's a matter of strengthening the surrounding muscles right so the goal is unnecessarily like progressive load and your IT band syndrome gets better it's about improving your movement patterns and then strengthening you to be a durable runner yeah thanks for for differentiating between those two things because I feel like even as someone who's a big proponent of getting in the weight room doing some heavy lifting I'm also very aware that that is a little bit more performance oriented whereas if you want to improve how you move if you want to build some injury resilience there are some different exercises that might be somewhat more effective you know it's a little bit more you know isolation exercises a little bit more of exercises they're going to help you move better rather than just worrying about how much weight is on the barbell. So, you know, thinking about ITBS at
as compared to other injuries, as we begin to start talking about treatment. Are there any things that are unproductive to treat IT band syndrome that runners might jump to because they had a different injury and whatever they were doing for that injury might have been very effective, but for this injury it's a little different. - Yeah, absolutely. I would say rest, ice, stretching, KTT, racing. All of those will not help this problem at all. We know that rest is not gonna do it. Like we said, short rest if you're really, in that high irritable state, which isn't gonna be the majority of people who have found this training, it is gonna, most people are gonna have it at a lower level. So rest isn't gonna help at all. Ice isn't gonna do anything. I would use ice if you want to for pain relief if it feels good to ice in the short term. Again, probably a couple days, that's all you'll need. But that's not really gonna do anything. KTT, racing, putting a brace on, they have those counter force braces, like you've seen for maybe tennis elbow, people put that around their elbow. The thought is to take tension off of the IT band and put that around your knee. Again, if it feels good while you have it on, you can use it, it's not gonna harm you, but it's not gonna be the long-term fix. And stretching, like we alluded to before, stretching isn't gonna do anything. And I guess a maybe a little controversial topic we'll talk about is foam rolling. And this is something that I give to my runners, but I do not foam roll directly over the IT band. And for this, because like I said, you cannot change the length or the tension of the IT band, what's key to foam rolling that I found really successful with this. And I kinda learned this at a little instrument-assisted course that I went to probably 15 years ago now. And kind of extrapolated that into, when I was in my clinical practice, using like the grass and tools into self-care on a foam roller that someone could do at their home, is to release just in front of the IT band. So that's your outside quad muscle, your bassist lateralis. And then also your outside hamstring muscle just behind the IT band, your biceps remorse. So if you can release those, it causes a little decompressive effect to the IT band. So you're not just mashing the IT band going at town thinking, you just need to like mash away at this thing. That's not going to solve this problem. And if you try to mash away down here, that you're just gonna piss it off and make it worse. So what I give my runners is to make sure you're not down at the knee, that your mid-cy or up at the hip, releasing just in front of the band, just behind the band, and then releasing those hip muscles that are gonna be important for you to be able to activate like we had talked about. So I guess foam rolling is one of those little controversial topics out there where you see people like do I roll the IT band or not roll the IT band? That's kind of my take on it. And from working with someone who's helped literally hundreds of runners with IT band syndrome, that has been quite successful. It will feel good while you're doing it. Maybe it has a little pain modulation effect. And it will just not feel, quote, unquote as tight. Yeah, I can affirm that. Foam rolling around the IT band feels somewhat amazing. It's just such a relief. I don't know why it feels so good, but it does. But let me ask you, like if I stretch out my glutes, the old sit down on your butt, cross one leg, let's cross my left leg over my right and really kind of hug my knee to my chest, that does make my IT band feel a little bit better. Like what's going on with that specific static stretch? That somehow is giving me a little bit of relief, even though like I know that I'm not actually stretching the IT band, I know that stretching isn't helping this injury, but I do feel a little better afterward. What's up with that? Yeah. So I think what you're describing is almost like what we'd call a pure form of stretch, where you're crossing one leg over the other. So your hip is in more external rotation, which does mean because the TFL muscle that the IT band connects to is an internal rotator. So you are getting a little bit of stretch of one of the components or motions. However, your hip is flexed and it is a hip flex or soda. In order to truly stretch it, your hip has to be an extension. So we're not stretching. And that's the problem with the IT band too, is there's three motions at the hip. And then there's a motion at the knee to actually fully stretch the structure. But in your case, like I would say, if it feels good while you do it, I would say not going to harm you by any means. You're not adding stress to it. So I would say, yeah, go for it. I think you're probably just feeling different components of the band or the muscle attachments feeling a stretch. And again, if it feels good, then yeah, by all means, go for it. This is probably a good chance to ask you a general question. I've seen a lot of coaches be like the science-oriented coaches where they need a study, a published research study, to make any sort of decision. And I think coaching is both an art and a science. On the art side of things, I believe that anything that feels good is probably good for you, even if there's no study backing it up. What are your thoughts on that? Feel free to poke holes in my very general thesis here. - No, absolutely. And that's what we talk about when we talk about like evidence-based medicine. It's really evidence-informed medicine because we don't have studies on everything that we do as runners or the best treatments and all the various treatments that are out there, the studies aren't there. But we do know that clinical experience. So for my clinician, let's say if you're seeing a good local running PT or medical provider, their clinical experience, the available research at the time. So what the literature is at the time. And then the third variable to evidence-informed medicine is actually the runner in front of you. And what are the variables that work for them and what kind of characteristics do you think will play the best role in getting them better? So it's not just the literature. We don't just focus on that. It is really all three of those elements that we kind of put together whenever a clinician or coach is making a decision. We're making that decision based upon all of those variables. So it's not one thing to say, if all runners said cryotherapy or bone rolling feels great, am I going to say every single runner should be doing that? No. If I know that, let's say cryotherapy or cold therapy, like the evidence really doesn't support it for actually getting rid of IT bands in drum, I'm not going to say that even if every single runner said to me like this feels great. And that's how any PT in my era would kind of describe the old ultrasounds. Many listening to this right now, you probably don't even see ultrasounds in PT clinics anymore, but in the beginning of my career, that was like one of the things. It was like the magic wand. Everyone thought it was the ultrasound that was getting them better, but it was probably the fact that their perception was, hey, this fancy machine is getting me better or-- I'm getting a little massage by this ultrasound head by my therapist. And my therapist is talking to me for five to eight minutes. And that's really making me feel better, because they're actually listening to me. And they're listening to my concerns. So it is one of those placebo effects. But we basically have to take into all of those variables. And I am a big proponent of yes, all of the research doesn't need to be there. We should help guide in our decision making. But then our clinical experience and seeing these patterns and seeing patterns of runners with IT band syndrome and knowing what exercises have gotten them better, what run programming that I've given them, how I adjusted their long runs leading up to their marathon, and they were able to get to the start line safely. All of that is in my brain. It's kind of like having an effect in my decision-making process for the next runner with IT band syndrome. So you are using some of those pattern recognition, we call it an experience that you have in overcoming something like this. That's why it is helpful to-- and I guess in this day and age of AI, as opposed to just asking chat GPT the answer, that's where a really good coach like yourself or a clinician can help really guide you better than just whatever information's out on the inner webs there. Yeah, you shouldn't only rely on what feels good. You probably should talk to some expert like a PT. It does seem like strength training is probably the most effective strategy for battling ITBS and keeping that pain at day. Do you have any favorite exercises that you'd like to give to runners? And I understand the progression is probably more important than the actual exercises. But maybe you can take us through a couple examples of beginner-oriented exercise, someone who's never really started strength training, and then a more intermediate and advanced exercise. Yeah, I love that. Yeah, absolutely. So in kind of, I created like a Spark 7, right? Seven exercises for seven muscle groups that really all runners, at some point, can have this workout in their arsenal. It takes 25 minutes to do. Three of those exercises hit the--
the main three muscles that are going to help with IT band syndrome. So the glute max, the fire hydrant exercise to help activate gain an awareness of the glute max. That one is actually backed by research and there's really good research on that exercise that I actually learned at our national conference three years ago now and started implementing it myself with my clients and yeah, I have definitely loved it. So that one's a great step one to kind of like find your glute max and be able to like feel it working. The other one is one that I kind of developed as a young clinician. I was seeing a lot of MLB players at the time and I was noticing some like weakness of like their side hip muscles. So it's kind of like if you think about the standard like sideline, you know, hip abduction leg raise, the problem with that exercise is a lot of folks compensate with the TFL muscle and their foot starts coming in front of the hip so they're kind of flexing their hip and really what we want to strengthen as runners is more the side back part of that muscle, the posterior lateral fibers of the gluteus medius. One way to do that little trick is a little hack for that one is to put your heel against the wall and slide up the wall, maintaining your body rolled forward so you're not rolling your trunk back and that will really feel a good burn in the outside hip muscles and I kind of coined it the humbler and literally everyone I give it to they're like that's a great name for the exercise because it was humbling. It looks super simple where you feel a good burn right on the outside part of your hip where you should be feeling that gluteus medius kicking in. So those are like two examples like level one if I had to say and then a nice little progression for that glute medius muscle that I like to do in standing is against the wall and you can either put like a physio ball, stability ball in between your thigh which is off of the ground and the wall and you're really working the standing leg. So you're focusing on keeping pelvis level. You're going to push outward into the ball or the wall if you don't have a ball. You're going to hold like isometric contraction five seconds but you're really focusing not only on the pushing into the wall, you're focusing on tightening your outside hip muscle and the standing leg and that's really key at preventing that hip drop that we talked about with running. So that's like a nice little bridge that I like to get to own to have that awareness in a standing position and then even a further progression to that is doing something simple like a drill like march with reach where you actually have to elongate, get long and move, travel where you're actually now allowing your foot to contact the ground, stabilize and now keep your pelvis level while you're reaching to the sky. So now you're kind of taking that activation of the muscle and now you're filter it through movement patterns and this is all before you even load. Before you get to a single leg squat with a kettlebell, right? Like you're just getting that awareness down and kind of transitioning it into lying down first, activate, isolate and learn how to do that and standing and then learn how to do it with movement. Yeah, I like this because you're starting from simply being aware of the muscle and how the muscle works and aware of the multiple muscles in the entire hip complex area. And you're not just going straight to like a pistol squat, you know, asking runners to do a one legate squat, which is arguably one of the more advanced bodyweight exercises that you can do. But I would also say if you can do a whole bunch of pistol squats, then you're probably not going to get IT band syndrome. You have this ability and the strength and the movement patterns that you're never really going to probably predispose yourself to this injury. Is this really the key then? Have we discovered the golden secret dwein? It's to get to a point where you can do like 10 pistol squats on each leg and you're probably ITB proof. Maybe. I don't know. Let's do a study on it. Let's see. Yeah, I need I need unlimited funds so I can conduct all kinds of scientific experiments based on the podcast and my coaching practice. Yeah, absolutely. Let's do it. Oh, man. So, okay, those are some great exercises. Let's talk a little bit more about the exercises that you would want to add some load to, you know, like I personally feel really good doing that marching exercise with the reach that you described. I sometimes like to hold a somewhat relatively light weight in my hand as I'm reaching just to add a little bit of extra load to the exercise, but what are some of your favorite weighted exercises to do for this injury? Yeah, and I think, you know, we had mentioned single leg squat. You can add a kettlebell to that. That would be one that's going to target that side hip muscle, the gluteus medius, but also worked quad, also worked the glutes. If you're really targeting the glute max, I'm a big fan of the split squat. That one is like no matter what like Jason, I've been in the gym strength training since college days and, you know, consistently no matter what like when I load that one, I'm feeling sore glutes the next day. Like I never feel dumb, really, but I feel sore glute every time I do that exercise. And the key to that one is really pitching the trunk forward. So you're getting a forward lean. So you're really allowing that hip to flex because it's going to transfer more weight. I think we started in the beginning talking about like downhill running, why we're, you know, getting that it's transferring to the knee. Here we're transferring more load to the hip. So you work your glute max a whole bunch more than your quad muscle in something like a split squat where your back leg is elevated on, you know, a bench, some type of surface. So that one I really like as a progression, you know, and definitely holding dumbbells, kettlebells. You're going to feel that in the in the glute max for, yeah, the glute medias. Another like kind of besides a single like squat, let's say where you're working more functional movement patterns, you know, why don't we actually go plyometric Jason because that is so important for runners and many runners skip that where they're not implementing jump training into their training when running as there is hops from one foot to the other side to side really kind of hop into one side and then hopping to the other called like a little skater jump from side to side really focusing on keeping the pelvis level and that you're not dropping. So you're now you're getting this like plyometric activity or even doing single leg hopping straight forward traveling, making sure your pelvis is staying level and it's not dropping with each step that you're taking. You can do like a little side to side like zigzag pattern, which challenges it even more so because now you're moving in and out and now those side hip muscles really need a fire to keep your pelvis nice and level. So that would be like more of a dynamic, I guess exercise, a little bit more agility, speed and challenging the muscle in a little different way than just strictly, I guess, loading it up. It always makes me think that some of the training you would do as a basketball player would be quite helpful for IT band syndrome because you know, the defense side to side drill that you do as a basketball player is very much like that back and forth skater drill that you just described and there's so much focus on that lateral movement side to side that it's going to build a lot of strength and capacity and ability to move in that particular plane of motion that you're not going to predispose yourself to some of the weaknesses and lack of movement patterns that make this injury much more likely for you to get. Yeah, and everyone just got the visual of Jason as a middle schooler going out for his cross country team and his basketball shorts, right? I mean, this happened my freshman year of high school. Yeah. Okay, I know you've told that story before. Basketball shoes, long mesh shorts, the whole nine yards, I thought I was going to high jump and then I just realized that cross country runners just run a lot every day and it's kind of a minor miracle that I didn't quit, but look at me now. Exactly. We'd maybe be talking like basketball and you know, March madness right now, but we're talking running. Yeah, well, it's my, what can I say? It's my number one love. Now, I guess the million dollar question is, Dwayne, what happens when when you're healthy? If you know that you are predisposed to getting IT band syndrome, what do you do once you're healthy to prevent ITBS from coming back? Is it a lot of the same things that we've been talking about? You know, let's make sure we're staying strong. We're doing some of the hip and glute work. We're making sure that we're being aware of the camber, the crossover gate, we're making sure that we're just being consistent with all of the training progressions and we're not jumping up and mileage too much. What else is there for us to stay healthy once we are healthy? Yeah, you just named the main ones, I would say, you know, I guess we're missed and not mention recovery wise, you know, lifestyle factors, sleep, making sure when you are building up, especially for like we said, most common for like marathon training cycle, that you're not doubling down on your sleep and your nutrition to make sure you're actually recovering properly from your hard long runs. And so your body can rebuild and can actually stay healthy. So you're not getting into like this overtraining cycle. Yeah, those would be the big, you know, prevention is like, as Shakira says, hips don't lie, so you gotta make sure you are doing some isolation exercises for, you know, those hip muscles. And just know that, hey, if I've had this before, if
I've had it twice before, like I know I need to keep some of these hip-specific exercises in my routine on a consistent basis. And as you're peaking in your marathon training, it doesn't mean you don't do any strength at all. You might be taking the strength down a bit in terms of like time that you're spending in the gym or time at home doing these exercises, but it is an important component in staying healthy as a runner as you continue to grow in your running journey. So you can do it for longevity. And that's what I definitely want for you guys is to be able to continue running, like I say, and tell them in the box, right? And one of the ways we do that is just balancing that strength training, recovery, nutrition, with smart training. And you know, not progressing. Like I know you guys had a very warm winter out in Colorado, but for us in the Northeast, like we had a brutal winter, this winter, Jason. So like now that spring is starting to finally happen and you're hearing birds chirping in the morning and people, you know, you get that sunny day and you just feel great. There's going to be so many runners in the Northeast. You're just going to want to be like, I just want to stay out here because this is amazing, right? But you have to have some restraint. And if you've only done a 40 minute long run, don't just jump to an hour and a half just because the weather is nice outside and it just feels so amazing. Like you have to have some restraint because that's how many of these common running related injuries will kind of, you know, get sparked up is by doing something like that. So kind of you got to have some restraint and prevent the old like runner error that can happen. You know, and I'll just add to that one of my more practical strategies for getting in kind of like the more targeted strength training, the isolated type of exercises that can be really helpful for the hips and the glutes is I include that as part of my warm up when I'm in the gym. So when I'm going to go do some squats or deadlifts and presses and whatever I might be doing, I warm up by of course doing some versions of those specific exercises, but then also doing some of the banded monster walks, some of the, you know, side lying leg raises. And so I'll warm up with some of the easier body weight or banded exercises. And then I'm much more ready to go. And I know I've covered some of my more injury prevention related strength training. And then I can, you know, do the squats for more performance or I can do some curls for the girls and things a little bit more for vanity. There's nothing wrong with that a little bit. And I know that I'm getting in both types of strength training for both of those types of benefits. Yeah, that's one of you mentioned that. And I've never heard curls for the girls. I like that one. I'm going to have to steal it. I think it's like being a little outrageous every once in a while. I just had a younger guy come up to me this morning in the gym and was like, Hey, man, I noticed like, you know, you do like all these like exercises before you even like lift a weight. And I noticed like it takes you like 20, 25 minutes. Like, what are you doing? Like, why are you doing that? And so it was like a little education moment for this young buck. He was probably in his 20s. And I was like, well, when you get to my age and you're 40s, you know, you got to do these things to kind of take care of your body. So you're activating the right muscles. You're getting some mobility going before you actually, you know, pick up the weights and start doing some of your weight lifting. But yeah, I think that's a great point that you make is is these can be those warm up. And that's what we should be doing before we are lifting heavy anyway is to really get activation of the right muscles, get more blood flow into the areas before we start like loading up, you know, the barbell or dumbbells, whatever that you are doing. If you are lifting heavy as part of your strength training. So yeah, great point there. Well, do I and thanks so much for helping us with this tricky injury. I have suffered through this injury for many different times. It's not fun. It can be quite painful. But I hope we've given runners a road map for both preventing it and some quick and easy strategies for treating it if it's not too severe and you can self-treat it. Of course, go see a physical therapist if it gets pretty severe. But Dwayne, if folks want to learn more about you, your work, you do some amazing things for runners. Where can they go? Yeah, well, if you're listening to us on the podcast, like Healthy Runner podcast, we'll probably be the best place or on YouTube, Spark Healthy Runner. And yeah, if you want to learn more specific strategies and how to really kind of prevent IT band syndrome from coming back, like we had talked about today. I have all those specific exercises in a download with all the videos. So you can go to learn.sparkhealthyrunner.com/itbrunner. Awesome. Well, we'll link to that in the show's description. Dwayne, thanks for your time and expertise today. Always great catching up with you, Jason. Thanks for having me. What an episode. Thank you so much for listening and being part of our community here. If you're getting value from the Strength Running podcast, if the show has helped your running or made you rethink how you approach your training, please consider leaving a review or a rating, an Apple Spotify or wherever you listen. Those reviews are incredibly impactful and helpful for this small business. If you have questions about your running, feel free to email me at
[email protected] or you can search our website at strengthrunning.com. For more digestible tips, videos, memes, and more, follow me on Instagram @Jasonfit1. We'll be in touch.
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