Amazon HOLIDAY SALE: Save 25% off shoe purchases with code 25OFFSHOES
Running Warehouse: Great prices on closeout shoes! View men's and women's selections.

Running Shoes and Iliotibial Band Syndrome (ITBS): One Runner’s Story

knee-iliA few weeks ago I received an email from a reader named Adam Krueger asking me if it was possible that a simple change in footwear from a stability shoe to a neutral trainer could essentially cure a fairly long-term bout with iliotibial band syndrome virtually overnight. This had been Adam’s experience, and he was wondering if I had ever heard of such a thing before.

My immediate answer was a resounding yes. Why? Because in my own life I have experienced bouts of ITB pain only twice, and in both instances the pain above the outside of my knee resolved almost immediately either with a change in footwear or with a modification to the footwear causing the problem (you can read about my experience with the latter here).

Now, I’m by no means saying that changing footwear is a surefire cure for ITBS – I highly doubt that it is, but given my experience it is one factor to consider (along with things like hip strength, asymmetries, etc.). But, I was intrigued by the similarity between Adam’s experience and my own, so I asked if he’d be willing to write-up his experience for me so I could share here on Runblogger.

Without further ado, here is Adam’s ITBS story:

If you’ve been a runner for a number of years, it’s likely you’ve suffered from some type of running-related injury. Among the most common of running injuries is Iliotibial (IT) Band Syndrome. It can happen for any number of reasons including: poor running form, overtraining, running too many hills and on and on. As far as injuries go, ITBS can be one of the most frustrating because it can take anywhere from a few days to a few months to clear up. This is the story of my struggle with ITBS and its seemingly unlikely resolution.

Back in January of this year I began training for the NYRR Half Marathon in New York City which took place this past weekend. I had been running regularly for the previous two years and was typically logging 80-100 mile months and was looking forward to the challenge of my first race longer than a 10K. At the time I was in the midst of reading ‘Daniels’ Running Formula’ (by Jack Daniels) and was feeling extra ambitious, so I formulated my own training program which was based off of one of his marathon training programs in the book. I modified the mileage a bit because I was only going to run a half, but I tried to stick to his principles of many long and slow miles highlighted by a speed (he calls them “quality”) workout or long run twice per week.

For the first month of training, everything was going swimmingly and I was averaging just over 30 miles/week. It was during the first week of February that I started noticing a pain on the outside of my left knee. At first I thought I had just bruised my knee because the pain, while noticeable, was more of an ache than something that felt serious – and it seemed to disappear after I stopped running. After a couple of days of that, I had a speed workout scheduled and that’s when things really got bad. After completing that workout I had sharp, stabbing pain in my left knee and could barely put any weight on my left leg. Walking down flights of stairs was terrible. I did some quick research on the internet and it became pretty obvious that I had developed a case of ITBS. I was in denial. I said to myself, “eh, I’ll take the next few days off, let this clear up and I’ll be back on my way.” Little did I know I would spend the next 6 weeks in pain.

After the denial-phase, I started trying different things. I started icing my knee twice a day and taking an ibuprofen regimen. I purchased a foam-roller and started rolling 2-3 times a day. I started doing several different leg-strengthening exercises specifically targeting my hip abductors, hamstrings, quads and calves. To compensate for not being able to run I did some pool running, biking and swimming. For the first couple of weeks, I would “test out” my legs every few days and every time I would make it between 1 and 2 miles before the pain returned, often reaching a severe level before I would shut it down feeling frustrated and defeated. After those first few weeks, I decided to incorporate rest into the mix and a couple of times went a week to 10 days without running at all. After resting for a week or more my legs would feel great with no pain at all and I would start to get excited. Then I would strap on my shoes, try to go for a run and between miles 1 and 2 the pain would start in again, inevitably causing me to cut my run short. As the race got closer and closer, I got more and more desperate. I purchased the Patt Strap, I purchased the Mueller Max Strap, I bought a new pair of shoes, I bought “The Stick”, I went and saw a physical therapist who recommended arch-support inserts which I ended up getting. Nothing I was trying was making any difference. Every time I would go out of a run the pain would start in again. About a week before the race I was telling my mom about it and I said to her, “it’ll be a miracle if I am able to run the race.”

Five days before the race it was sunny and 70 degrees here in Chicago and if you’re from this area, you know how rare that is for March. I got home from work and I was DYING to go for a run. As I was sitting in front of my closet putting my socks on, I noticed an old pair of running shoes towards the back of my closet, a pair of Saucony Ride 2s that I had retired last November. I had since switched to the Saucony Guide 5s last December after visiting a running store and being told I needed a support shoe due to over-pronation. I had been switching between the Guide 5s and a pair of Brooks’ Green Silence for quicker runs. I saw the shoes sitting there, lonely, in the back of my closet, and thought to myself, “what the hell, I’ve tried everything else, I might as well see if a different shoe changes anything.” I loved the Ride 2s. I never had any injuries while running in them and had retired two pairs before switching. Those shoes made a WORLD of difference. I completed a 3.6 mile run that evening and when I got back to the house, I called my wife, my friends and my brother (all runners) to tell them the great news. A couple of days later I had another pain-free 3-mile run and was willing to give the Half Marathon a shot…I hadn’t run more than ~3.5 miles at a time in 6 weeks, but I so badly wanted to run this race.

During the half marathon I had some discomfort in the knee that started between miles 4 and 5 but it never rose to the level of “pain” and I was able to complete the NYC Half in 1:45:02. I’m not a crier, but I started crying after I crossed the finish line. I had all but given up hope that I was going to be able to run the race, let alone complete my first half marathon in a respectable time. At this point, I am convinced that a shoe-change played a large role in the development of my ITBS. It didn’t occur to me right away because I’d run 100+ miles in the new pair before the onset of the ITBS symptoms. To all you ITBS sufferers out there – I feel your pain! Though shoes may not be able to prevent injury, it seems more than possible that they can cause an injury if you choose the wrong ones.

If you’ve had a similar experience, we’d love to hear about it in the comments!

Running Warehouse: Great prices on closeout shoes! View men's and women's selections.
Amazon.com: 25% or more off clearance running shoes - click here to view current selection.
Trivllage: Save 18% on run, swim, and cycle gear. Use Code: RBTri18.

Recent Posts By Category: Running Shoe Reviews | Running Gear Reviews | Running Science

About Peter Larson

This post was authored by Peter Larson. Pete is a recovering academic who currently works as an exercise physiologist, running coach, and writer. He's also a father of three and a fanatical runner with a bit of a shoe obsession. In addition to writing and editing this site, he is co-author of the book Tread Lightly, and writes a personal blog called The Blogologist. Follow Pete on Twitter, Facebook, Google+, and via email.

Comments

  1. I agree completely, changing from a stability to neutral shoe made a world of difference for me. I’ve also used the strap that holds the ITB tight so that friction doesn’t build up. Changing shoes was an easy fix for me and I’m glad to hear it has also worked for someone else.

    • This is so interesting– and exciting! My college cross country and track career ended prematurely because of chronic IT band pain– the whole time, everyone from my coach, to the trainers, to shoe sales clerks kept telling me that because of the IT band problems it was essential that I always use a stability shoe. Not wanting to risk worsening the problem, that’s exactly what I did…. now I’m thinking that I was making it worse by following their directions. THANK YOU! I am going to try a neutral/minimal shoe and see if I can actually run again for the first time in years.

  2. Adam,

    Congrats on getting to a solution of this injury. I am quite certain your experience is shared by many people. Based on your story it sounds like stability footwear is not the best shoe option for you. It appears that it forced you to run to laterallly and thus overstressed and irritated your ITB. Stick with nuetral footwear to afford yourself an ideal platform with which to have your best technique for running injury free.

  3. Ghgreyhound10 says:

    I too had a bout of ITBS 11 years ago that stopped me cold from any running.  Having tried everything I found someone who did active release technique (ART) within the space of three sessions I was up and running again.  I can’t tell you how many times in the past 11 years ART has helped me with running related injuries and got me back on the road.  Breaking up that scar tissue is critical to allowing the muscle to function properly again.

  4. I don’t know if it was ITBS or just my knees getting out of alignment.  I found that my out of alignment knees usually were cured after one hard 3 to 4 mile run in very minimal shoes with almost no padding or structure.  About 7 years ago I was using some Pumas for that problem even though they were kind of narrow.  I am glad I have so many more options now.  So many people have told me over the years that running was bad for my knees.  My experience is many low impact exercises lead to my knees becoming misaligned.  Stairmaster machines, Cycling, and walking in heavy steel toed work shoes are all worse than running.  The last time I had sore knees I found the problem was my heavy cushioned work shoes.   Structured running shoes do not cause the problem as long as I run fast in unstructured shoes a couple of times a week.  I now wear Altra Instinct shoes to work in and many different running shoes.  My favorite running shoe  right now is the Inov 8 Road X 155.

  5. Ccbressoud says:

    I, too have a similar story.  IT band issues started early in the beginning, but I was not doing any strength training.  I have run in Brooks Adrenalin since I started running 8 years ago.  As I am getting older (58 soon) I thought I should get a more cushioned shoe, so I got the Brooks Glycerin, I began having problems right away, so I went back to the old ones, then I began reading about natural/minimal running.  And started reading reviews which brought me to your blog.  I am now running in Saucony Kinvara 2′s,  I love them, I also am using the Peregrine for winter(not much this year) and trails.  A bit of tenderness getting back outside after the winter, but that is all.  Thanks for your very careful reviews.

  6. I haven’t had the same issue as your reader above, but I had a different injury that might have resulted from wearing stability shoes. After I had problems with my peroneal tendons, I had my gait reanalyzed by the same store with two different clerks- one of which did the original analysis. In the 2 1/2 years I had been running seriously my gait improved from overpronator to neutral (more so in one leg than the other). The clerk mentioned that ITBS could be a result of being in the wrong shoes. I have been very happy running in the Brooks Ghost 3 and 4 models ever since.

  7. Theo Schultz says:

    I’ve had a very similar experience.  If I run in any shoe that has substantial cushioning, my ITBS flares up.  Even shoes like the Altra Instinct or Merrell Bare Access cause me problems.  I need shoe that is very firm underfoot like the Altra Adam or VIVOBAREFOOT  EVO. 

    • Pete Larson says:

      If you like those two shoes, check out the Inov-8 Bare-X 180. It’s a personal favorite right now!

      • Theo Schultz says:

        I have the Bare-X 200 and love them.  I know they are exactly the same except for the upper which I think I would prefer the upper on the 180.  I love the way they feel underfoot and the outsole seems to be extremely durable.

      • I bought the Inov-8 Bare-X Lite 150, 

         last Year. Great shoe, little on the expensive side(~$120 MSRP); so I am saving it for later and spending a lot time with the NB730($62 Sports Basement, amng others); I suppose the 180 is comparable to the 180(6/6/0)!? 

  8. I have has PF for 7 months. Long story it has been gone for 3+ weeks now thanks to my Altra Instincts. I think that the other shoes I was wearing were too tight in the toes. I noticed that I push off with the toes if the shoe is to snug. I have had great luck on trails with going up from a 12.5 in my MT-10′s to a 13 in my MT-110′s. Same theory more room= less push off= less pain for me.

  9. April Boultbee says:

    That’s sort of happened to me in the past.  I normally run in neutral shoes, but was given a pair of shoes from a sponser that were stability shoes.  I thought, might as well give them a try – free shoes after all.  Tried running in them for just a few weeks and developed knee pain that would come on in each run in these shoes. 
    I figured it was the change in shoes and quickly went back to my regular neutral shoes and the knee pain quickly went away.  I’m glad I made the switch back after only a few weeks in the other shoes.  Now I know for sure – despite what running shoe stores tell me (I have really flat feet and am constantly told I need support/stability in my shoes) – that neutral (and now minimal shoes) are what work for me. 

  10. Just wanted to thank everyone for the helpful comments and stories. My wife and I have both been suffering from ITBS for quite some time now. We love to run, but thought we’d have to give it up. We’re getting serious this week about a strengthening program and will also look into trying a more neutral shoe. We will comment back on our progress. Have a 1/2 Marathon coming up quickly. Thanks again for the tips!

  11. Jeremy Gustafson says:

    This is ironic for me as I didn’t develop ITBS until AFTER I started running in minimalist shoes.  Granted, running in minimalist shoes cured my patellar-femoral syndrome of which kept me from doing much running at all for a few years.  I was having so much fun running in my new-found fivefingers that I overdid it and end up with ITBS.  I also went from couch to a 25k trail run in about 5 months with no cross-training and running too hard.  Now, as long as I am doing my glute-activation exercises and stay in my aerobic zone, I don’t have issues.  Cross-Training and Strength-Training are key for me to keep from developing over-use injuries!

    • Pete Larson says:

      Curious- what exercises do you do for glute activation? This is becoming a hot topic these days.

      • Dr. Larson -

        In Brian Martin’s book ‘Running Technique’ he, at length, talks about ‘Glute Activation’ exercises, with pictures no less(Chapter 9)! Quite helpful. His book/technique is all for running with ones ‘Glutes and Hamstring’ and proper timing of hip extension and knee flexion.  After a quick read of his book, the video of ‘Meb’  in slow motion, that you had posted last year:

        link to runblogger.com

        beginning to makes sense in me thick head.

        My 2C.

  12. Tonni Tielens says:

    Thanks for this post. I more or less have the same situation, although I only recently switched to neutral and minimalist shoes and am not yet at the phase were I can run many miles without any IT band pain.

    My IT band syndrome started beginning this year after increasing mileage and speed for the Rotterdam Marathon. I was running on very supportive and cushioned Brooks Adrenaline GTS shoes. After going to the PT I was advised doing stretching, stability and strength exercises. I’ve did those for the past seven months without any major result. Occassionally I would feel good and would increase my mileage a bit, only to find myself having pain again the day or week after.

    So last month I decided to get rid of the supportive shoes and bought me a pair of Kinvara’s, after reading similar stories like this one. The first run went great. I ran 3.2 km (about 2 miles) without any pain. Then I got a bit overenthousiastic and did a lot of running in the week after. The IT band got irritated again. And now even on both legs. I think (and hope) it’s because of my overentousiasm. The first run really felt great. So I’m building it up very slowly now. Ofcourse going from supportive and cushioned to neutral and minimalistic shoes is a big step and requires some patience, so I will just try to build things up very slowly from here.

    Anyways, thanks for the post. Here’s my story in my own blog: link to tonni.nl

  13. I am SUPER DUPER grateful for your post! I have been struggling with ITBS for over a year and it has been more mentally painful than physical. I so want to get back to endurance running. I got new shoes after my initial flare and I got orthotics…..Still can’t run more than 5. I had really good pain free beach runs and now I’m going to try minimalist shoes for a second time….the first time I had some heel problems. Anyhow I just want to thank you for sharing. Reading your post and the responses is giving me hope for sure!

    • Pete Larson says:

      Good luck, feel free to email me if you need shoe advice, or post in the forum.

      • Tracey Clark says:

        Pete, I’m really grateful for your post about this as well. If you wouldn’t mind i’d love your advice on running shoes. Your experience sounds almost identical to mine. It would be MUCH appreciated.

        • What kind of shoe are you in now, and what are you looking for?

          • Tracey Clark says:

            Sorry, Pete, didn’t see that you responded to my post in my email (oops). I was wearing (before injuring myself) Mizuno Wave 10′s which I believe contributed if not caused my IT Band problems. I want something that I can just wear normally running, casual, but also something with serious running in mind. I’m still not completely healed. I can feel pain when walking quckly and any kind of jumping motion. I’m still spending time healing and doing other physical activities like swimming and strength training / stretching.

  14. Have you had any further contact with Adam? I am just curious if he continues to do well since my situation is quite similar. I have been plagued with injuries over the last year and a half, Achilles’s Tendonopathy, ITBS, Posterior Tibial Tendonitis. All of these have been while in Stability and/or motion control shoes. I finally got fed up and did my miles this week in some Nike free 3.0. The first two days had some IT pain associated but this morning my 3 miles were pain free. I am not going to throw the miracle sign quite yet but things are looking hopeful. I have also just started reading Tread Lightly which has been quite informative. Thanks for all your information!

  15. Chrystal says:

    Same story with me. I struggled for 3 years. I saw several orthopedic surgeons and sports medicine doctors, PTs, yoga, and an MRI. I was set on my goal to run a marathon, but wasn’t sure how I was going to do it-almost ready to give up because the knee pain would never go away, and even progressed to also cause some numbness and tingling in my shin and foot-the start of compartment syndrome. I switched from Brooks with a higher heel-toe drop to Saucony Mirage, and I also was foam rolling and doing pilates reformer to improve my hip strength. I ran my first marathon last October!

  16. Erica Michaud says:

    What minimalist shoe do you recommend for someone with itbs? My story is pretty much the same as many others

  17. I had terrible ‘shin splints’ and other knee pains.  I first went minimal in old water shoes running running 200m each day.  After learning proper form (from this and other websites), I slowly returned to my original mileage with no pain.  This was about last April.  I go to school in Vivo Aquas and run in ZEM originals and Vivo Ultras.  It has been about 10 months since I have been in a shoe with a heel-toe drop.  By the way,I find that all ‘barefoot’ shoes are bad substitutes for the real thing.  There is nothing like warm pavement on a cool summer evening.

  18. Brian Martin says:

    Great story, I think motion controlling shoes can do a similar (bad) job as some orthotics. You can end up with lazy buttocks, the switch back to a neutral shoe and the butt wakes up again. Lots of success stories (and some science) around about resolving ITB syndrome through strengthening the hip abductors and external rotators (buttocks). More on this here http://www.runningtechniquetip

  19. Megan@ Run Like a Grl says:

    Just wrote a blog post about this same issue (http://runlikeagrl.blogspot.co…. I started feeling knee pain a few days ago and am taking some time off to see if it gets better. I hope it doesn’t take 6 weeks like this story, but Ive been running for a while now and this is the first time I’ve felt any discomfort. I have custom orthotics so I don’t think changing my shoe is the answer for me. Not sure though, but I am foam rolling and using the Stick like crazy!

    • Sun Recruiting, Inc. says:

       That’s the thing with ITBS (and a lot of other injuries); it’s different for everybody, different causes and different solutions. I’m glad to hear you’re running pain free!

  20. Josiah Campbell says:

    Pete wanted to get your advice/suggestions on a new pair of shoes. I too suffer from chronic knee issues (in my case It’s not ITBS, but rather just over use from years of football, wrestling and baseball). I use Kinvara’s for shorter runs and speed work but find they lack the support/cushioning for longer runs during my ramp up to a marathon.I currently run in Asics Pulse 2 for my long runs, I love the forefoot cushioning as i land more midfoot/forefoot, but am looking for something more minimal with a lower heel/toe drop for those long runs and to race in. Any suggestions?

    • Pete Larson says:

      You might take a look at the Saucony Cortana (4mm drop), Saucony Triumph 9 (8mm) or Guide 5 (8mm). Fit is similar to the Kinvara, but a bit more cushion and support.

  21. Sun Recruiting, Inc. says:

    It’s really cool to hear how many other people’s IT band issues have come down to footwear. I think it really is incumbent upon running specialty stores to figure out reliable methods of identifying what kind of shoe is correct for a given person – one positive thing I’ve seen in a number of store is gait analysis using video equipment and that’s a step in the right direction for sure.

  22. I currently have ITBS. I have an appointment with a physical therapist tomorrow to check my gait on a treadmill. I had my second baby in April 2011. I started running after 5 weeks of giving birth. Everything was fine, until Dec 2011. I stopped dead in my tracks during a run because of sharp pain on the side of my knee. I waited 3 months to have an MRI done, since rest didn’t help. MRI came back normal. I had no idea that We even have a band of thick fascia running from our hip past our lateral side of the knee, until I did more research. I went to see an Orthopedic and he mentioned IT band friction syndrome (exactly what I read about on the internet). He said that my arches of my feet are really high and that I should go to Meijer to stand on that ortho machine that tells you  what $50 insert to buy for your shoes. That appointment with him was last week; and last night I started different stretching methods and I am going to purchase a foam roller. I can’t wait to see what they find tomorrow at therapy.

    • Pete Larson says:

      Good luck, I’d be curious to hear what turns up in your gait analysis. My guess is they will be looking for opposite side hip drop when you are in stance on the ITBS leg. Would be a sign of weak abductors (gluteus medius in particular), which has been linked to ITBS.

  23. Jeff Heath says:

    Just want to echo that I’ve had a very similar story. I’m just at 2 years of suffering with ITBS. It is a maddening injury, because you can try different things, but it is so hard to pinpoint what is helping and what isn’t. I’m just a running sack of confounding variables. And even if you find something that you think helped, all of a sudden you get the symptoms again. I’ve tried so many things. I’ve finally just resigned myself that I’m always going to suffer from this, so I’ll just limit my miles and essentially become just a causal jogger. Currently it still hurts, but I don’t get the stabbing knife in the side of the knee pain anymore, at least not yet. I’m sure it will return if I start ramping up my mileage again. I envy the people that only have this for a few months.

  24. Yes, know from clients reporting these kind of issues after switching shoes most often too anti pronation shoes never the other way around. The medial block might in some cases force the knee in a more or less varus position, this increases stretch on the ITB. This together with the reduction of natural pronation to dampen the impact from landing might be one of the causes of ITB injuries when switching shoes.
    Another or adding factor leading to ITB injury is indeed runningform. Just like that; link to youtu.be

    • Pete Larson says:

      This is interesting – wonder if anyone has attempted to link knee varus torque with ITBS incidence as they have with ostoearthritis? Reminds me of the Franz study that showed that even having a cushioned insole with medial support can increase knee varus torque: link to ncbi.nlm.nih.gov

  25. Dave Sabol says:

    Pete,

    I had to pass on the opportunity to run the NYC Half a few weeks ago because my left IT Band severely hobbled me. I had a previous bout with the right last fall and went into rest and rehab mode. After the first incident I had worked with my therapist to develop an effective stretching and strengthening routine, replaced my old shoes with new Brooks Ravenna’s and had custom orthotics made. I was hopeful that the worst was behind me. Adam’s story sounds so familiar that I could have written it myself.This most recent bout had me seriously doubting any long distance running but I resolved to get the bottom of it. As I researched what I found that my stretching was focusing on the wrong body parts, and that the “extra-shoe” that the Ravenna’s provided in combination with the orthotics were probably making things worse instead of better.

    I began strengthening the TFL (and really the entire hip region) and continuing my stretching routine, but stayed off the road. Using your blog as inspiration I decided to dive into a more minimal shoe – the Brooks Pureflow – and got back on the road earlier this week. While I’m not cured I’ve noticed a significant improvement both in terms of pain and overall performance. I’ve been focusing on my bio-mechanics and achieving a good mid-foot strike and despite a 3-week hiatus, I’ve been logging 30-45 second faster miles with much less effort.So to sum things up, a few weeks ago I would have flat-out denied that moving to more minimal shoes could have provided any benefit, but having experienced what I did, I’d have to say that I think it’s a large part of the equation.

    • Pete Larson says:

      Thanks for sharing – despite all of the talk these days about running shoes, it’s amazing how often people who are injured fail to consider trying something different to see if it might help. Glad things are working out for you!

  26. I had very similar experience. For most of my life I hated running because I couldn’t run for more than a couple of miles without ITBS flaring up. I was told I had to have the most motion-control shoes I could find, adidas Salvation, because of severe overpronation. Salvation they were NOT. Then one day I decided to buy Nike Free 3. I can’t even claim it was because I started believing in minimalism – they just looked cool. Of course the guy at the running store gave me a “you are crazy to switch from Salvation to Free” look and I had to listen to the obligatory “transition slowly” shpeal. Well, the feeling was so different and liberating that I transitioned 100% on day one. I’ve since moved on to NB 110 and 730. Now I am able to run marathons and haven’t had an issue since.

    • Pete Larson says:

      Fantastic, glad the switch has worked out for you! I think the shoe fitting process is in a major state of flux right now, and the old model is on its way out.

  27. Kleinruns says:

    I too used to have ITBS problems.  A few years ago I was fed up with injuries and began my search for cures.  This lead to my interest in physical therapy and my exercise science major that I am currently working on in college.  
         As a college athlete I stopped going to the trainers because their advice never seemed to help.  Even when I began training in minimalist shoes the ITBS would come back (though not nearly as bad as when I was running in high support shoes).     My solution was to look at the insertion points of the Iliotibial band and any attached muscles.  The small muscle essentially attached to the IT band is the Tensor Fascia Latae.  This thing is tiny.  Since it is on the lateral side of the leg, one would assume that it’s purpose is lateral motion.  If the IT Band is hurting at the insertion point (usually the knee), it may be getting pulled to hard and there may be some damage at the connection point.  I wondered if the knee would rotate or fall in medially if the Tensor Fascia Latae was weak.  Realizing I had very weak hip abbductors (responsible for lateral movement of the legs) and hips in general.  I began strengthening those with lateral leg raises on both sides every day.  Eventually I added Bridges, Donkey Kicks, Planks, and more to my essential after-run core routine.  That was 2 years ago and I have not suffered IT Band pain or an injury since.  The point is that traditional motion control shoes will cause all the natural stabilizer muscles (just because I said stabilizer does not mean you should get a stability ball, bosu ball, etc for training on.  Go talk to Steve Magness about why unstable training doesn’t really  work for running) to atrophy.  The body is inherently lazy and won’t do work if it doesn’t have to.  Even with the amount of hip strengthening I have done, when I step out of my Altra Instincts and into some high support shoe just to see how it fits (I work for a running store during the summer), running for more than 3-4 minutes in it causes some kind of hip pain, usually in the form of IT band tightness.  So get away from higher support shoes, look into minimalism to some degree (even if just as a training tool) and strengthen those hips.       Also work on your running form.  Landing with a pronounced heel strike with a choppy, short stride leads to very high impact forces.  I understand that cadence is important to a degree, but when most people try to hit that 180 steps per minute they acquire a very short stride.  As stride length increases, shock attenuation increases (Mercer et al, 2003).  That does not mean that your base of support (where you land in relation to your center of mass) should be way ahead of you with a heel strike.  Heel striking does have a higher injury rate as well as higher impact forces than mid/forefoot running (Lieberman et al, 2011). It is also good running form to drive with your knees when you run rather than push off from the with the ankle.  The achilles stores elastic energy when you land with a midfoot/forefoot strike pattern and will release it naturally.  Don’t worry about push-off as much and just focus on lifting your knees.  Your calf muscles will thank me.

    So get out there, work on your running form, strengthen your hips in as many planes of motion as possible and run happy.  -Matt KleinUniversity of Puget Sound ’13, Exercise Science
    1.  Daoud, A.I., Geissler, G.J., Wang, F., Saretsky, J., Daodu, Y.A., Liberman, D.E. (2011).  Foot Strike and Injury Rates in Endurance Runners: A Restrospective Study.  Medicine & Science in Sports & Science, Published ahead of print.2.  Mercer, J.A., Devita, P., Derrick, T.R., Bates, B.T. (2003).  Individual Effects of Stride Length and Frequency on Shock Attenuation during Running.  Medicine & Science in Sports & Science, 35(2), 307-313.

    • Thanks, very helpful!!

    • Mario Hernandez says:

      Hi Kleinruns!

      Wow! This was such a good comment. I love that you cited some authors. Did you come up with some kind of tesis as a result of your exercise science major? I would definitely be interested in buying it.

      If not, do you hace any more info you could share? I would appreciate it very much.

  28. reeveo123 says:

    Never had ITBS (knocking on wood). However, I was diagnosed with a left lateral meniscus that is “shredded” (the Doc’s words). At times the knee would become painful, swollen and I would lose a noticeable amount of flexibility. I had been running in Asics 1150 and Brooks Ravenna (mild stability). I began a process of slowly introducing “less” shoe into the mix. I began with the Brooks Defyance (neutral) and Racer ST. Then I literally dropped down to the Brooks Pure Flow and Grit and Saucony Peregrine. 
    I now run with a pain free knee without the surgery that was suggested. I can’t say that’s what “fixed” it but my gut says that there is more than mere coincidence to it. I know the tear did not fix itself, it’s still there but for some reason it no longer impacts my running. 
    Now that sfx I have in my right foot at the moment, well…

  29. Kevinwschell says:

    I had similar experience with ITBS in 2010. It began when I purchased a pair of Nike Zoom Structure Triax 13′s. I believe that the thick cushioning and highly controlling medial post allowed me to “comfortably” heel strike with a nearly straight leg. In other words, the cushioning and footstrike control elements of the shoe eliminated or masked the proprioceptive signals that normally cue me to bend my knee. Threw the shoes in the dumpster and haven’t had ITBS since.

  30. Do you think this could happen if you’re using the same brand/style? I developed ITBS last fall during half training and the only thing that changed were the shoes. I kept the same brand and style BUT since shoes vary even within the same style/brand, could it be that? Should I switch back to my other shoes?

  31. Tonni Tielens says:

    I posted a message here too a few days ago, but for some reason it got removed. Anyways, I’ve been having IT band syndrome for seven months now too. After trying different things like stretching, icing, rest, strength exercises, etc., I recently got rid of my super cushioning and supportive shoes and bought a pair of Kinvara’s.

    I’m still in the process of getting used to such a minimalistic shoe (although the barefoot runners would most probably shoot me for calling this a minimalistic shoe), but they feel great and my IT band is in the background at the moment.

    • Pete Larson says:

      Tonni,

      I managed to find your other comment – it got flagged by my comment software as spam for some reason. Anyway, it’s now live here as well – thanks for sharing! Did your PT have you doing glute muscle strengthening, and did they take a look at your gait?

      Pete

      • Tonni Tielens says:

        Hi Pete,

        Actually my PT gave me lots of exercises, but no real glute muscle exercises. I already did some core stability exercises, but it’s only since a few weeks that I’m doing lateral leg raises, which really seem to help.

        Also, my PT did not take a look at my gait.

        I have an appointment with a sports doctor on Friday. Most probably he will take a better look at my gait.

        Tonni

        • Pete Larson says:

          Hopefully they’ll take a look at your gait – things to look for are dropping of the hip on the non-stance leg and excessive adduction of the stance leg (thigh angled inward with little space between the knees when they cross). Glute medius strengthening can help with this, as can gait retraining. It could also be a shoe issue, lots of possibilities which is why a comprehensive analysis with a therapist is wise.

          —-
          Pete Larson’s Web Links:
          My book: Tread Lightly – link to ow.ly
          Blog: http://www.runblogger.com
          Twitter: link to twitter.com
          Facebook: link to facebook.com

          • Tonni Tielens says:

            No real news, only that the sports doctor feels that with the current condition, exercises and training program, it should really be over in about four weeks. I’m doing the correct exercises, stretching and he was also convinced that I was wearing the correct shoes and having the correct gait. So, let’s see what another four weeks will bring me. :-)

          • Pete Larson says:

            Good luck!

  32. Misszippy1 says:

    A horrible bout of ITBS is what got me interested in minimalism to begin with. I had help to get rid of it from the Sock Doc, but wearing low heel-to-toe drop shoes has kept me pain free. I’m a believer!

  33. Deidre Skrudland says:

    Wow, this blog totally applies to me.  I recently suffered from ITBS (for about 1 1/2 months) and for the longest time could not figure out what had caused it.  It finally dawned on me that it might be my new-ish shoes (Asics Gel-Noosa – stability shoe) and after switching to the Brooks PureFlow (neutral shoe) my IT band issues have completely disappeared!  Lesson learned: neutral runners do not need extra stability!

  34. Scott Crawford says:

    I struggled with ITBS for six months in my Asics. I switched to Nike Vomeros to see if they would help. Things got a little better, but not much. I transitioned to a forefoot/midfoot strike in the Nikes until I could afford a pair of Newton Sir Isaacs. Since switching to Newtons two years ago I haven’t had an issue. The shoes were definitely the issue for me.

  35. Reinhardtsgirl says:

    Yes I Have had This happen. It is just another reason we should use a log and note shoe changes!

  36. Same. Exact. Situation. I wore minimalist, neutral shoes for a long time before being told that I needed a more supportive shoe. I bought a pair by New Balance and began to develop IT band problems. I fought with these shoes for a while before switching back to my Adidas minimalist shoes and the problems have basically gone away. I continue to foam roll and do clam workouts, but ultimately, I believe that it was my shoes.

    Thanks for confirming my feelings! Great article!

  37. Cassandra says:

    I had the same experience when I first tried the Kinvaras. Despite loving the feel of the shoe I started to get ITB pain within a few weeks of switching and I hadn’t had ITB issues in years. I wondered if it was due to the change in shoe so I took them back to the running store and exchanged them for a slightly more supportive shoe (but still less supportive than what I had been running in previous to the Kinvara) and the pain went away immediately. All that time I continued to do my speed workouts in racing flats and never had a problem. So I wondered if the high degree of cushioning in the Kinvara was more the problem rather than the lack of support. The weird thing was that a year later I decided to give the Kinvaras another try because I liked the feel of them so much and I loved them! I was cautious at first–only using them for short runs and at that point I had been experimenting with several less supportive shoes in my rotation so perhaps I had also built up more strength. I haven’t had a problem since although I still use my more supportive shoes for very long runs.

  38. srkevin says:

    My ITBS started while training for the ’09 Chicago Marathon in Asics 2012s (now 2016s?).  I was able to finish after much physical therapy and trained for the ’10 Chicago Marathon with the same issues, same shoes (newer model), but DNF’d at mile 15.  My pain usually started when mileage began to ramp up to 10-15 miles during the training cycle.  I have since gone minimal (Saucony Kinvara, Merrell trail glove, New Balance Minimus road all in rotation), without any problems.  I have also been strength training my core and ITB muscle group, as well as going to a midfoot strike.  All of these changes combined have kept me injury free for the last 6 months. 

  39. kamilothoris says:

    Without further ado not adieu. The italics did not make the French become Shakespearean English.

  40. ITBS is one reason why I quit running about 7 years ago.  Then about 2 years ago I decided to try running again.  The ITBS came right back after my mileage increased.  One problem might have been that I was running in the same shoes.  That’s when I decided to give barefoot running a try.  At the same time I very actively began foam rolling and stretching the area.  Within a couple of months it was gone and hasn’t come back.  I ran my first marathon 5 months ago and wore VFFs.

    • Sun Recruiting, Inc. says:

       I’ve heard from a number of people that barefoot running helped them with ITBS – I don’t think it’s the answer for everyone, but hey – all that matters is what works for you.

  41. David H. says:

    It’s reassuring to read this story. I developed ITBS in late 2010, but I stayed in the same shoes through my comeback. In mid-summer last year I added a neutral shoe into my rotation and stayed injury free through a marathon training cycle. Then this winter I have made a complete transition with no major issues to Saucony Mirage. Now when I wear my old shoes just to walk, something doesn’t feel right.

  42. i have been having itbs for a bout a year now, since i have been doing longer runs (anytime over 18+) and especially if there’s a lot of downhill. on my 2 previous 50K races and my most recent 50 miler, i had this issue after 20-25 miles. it is absolutely crippling, there’s a sharp pain every time i step at my right outside knee. i could not figure out what was wrong, and how i got this problem. i have been running in my altra superior and lone peak for couple of years now which resolved my PF issue for good. i’m running longer and stronger with my new running form and shoes but i just cannot figure out this itbs problem.

    then just yesterday i noticed i cross my legs whenever i am working at my desk. i cross my right leg over my left out of habit- don’t know why i even started sitting this way. but i think this could be the cause as my right IT is being stretched (or over stretched).

    i hope this is the cause and i will change my sitting position.

  43. My doctor recommended a golf ball muscle roller for my ITBS, surprisingly worked very well, check it out!! link to zzathletics.com

  44. I currently struggling with the same thing so it’s absolutely reassuring to see this article. I had an MRI last night which confirmed there is no real damage. But the pain is still quite acute after 2 miles. I firmly believe I need different shoes. I had upgraded from a Saucony Triumph 10 to the 11 and just found out they changed the shoe. How do you find a truly knowledgeable person to fit your shoe?? I wish I knew…

    • Oh, oops…meant to check off the notify box too…

    • For ITB, do you have anyone who can take a look at your running form to assess hip mechanics? That could be telling. We use strengthening and form cueing for ITB issues along with soft tissue work. A shoe change can also sometimes help, but not in every case.

  45. Hi Peter-
    I am desperately searching for the cause of my ITBS. I have the typical pain on the lateral side of my knee, but I also have tightness in my hamstrings and while running I develop pain in my calves and knees that limits my running to about 60-90 minutes.

    I switch shoes often b/c I run 50-80 mpw, so the lifespan of most shoes is less than 6 weeks in my rotation; thus, it is difficult to say which, if any shoe is the culprit.

    I run trail and road, but recently began running often on the treadmill. It’s possible that the treadmill is the source of my problem, but I have run 20 miles on the treadmill before and 50 mile weeks on the treadmill during ice storms – without issue.

    When I run trail, I run in Salomon’s XT S-Lab, Brooks Cascadia, Saucony Perigrine, and Brooks Adrenaline.

    On the road, I wear Saucony Grid Type A6, Inov8 155, and Asics Nimbus 15.

    On the treadmill I wear Mizuno Wave Universe 4 and the Inov8 155′s.

    I have run countless 50K’s and a few 50 mile races. I was looking to run my first 100K two months ago, but this “injury” has limited my running since November 2013.

    I’ve seen a PT, MD, Chiro, and DPM- with no success. The PT helped, but the tightness and soreness continues to limit my distance and volume. The doctor said to lay off running. I tried that, with no improvement (after two trials of not running for 7 days).

    I continue to swim (8,000m/week) and ride my bike (100 mpw) without issue (although I get a pinching feeling in the lower lateral portion where my quad meets my hamstring (directly over the IT Band).

    Any constructive input is greatly appreciated.

    • Couple of things.

      1. Keep a log of shoes as they relate to pain. Look for patterns. I’ve had ITBS twice and both times it resolved with a change in shoes. But that will not always be the case.
      2. Not sure if any of the therapists looked at your form, but one of the first things I look for in clients with IT band problems are issues with hip stabilization. Namely does the thigh cross to far toward the midline during stance – this can put stress on the IT band. Another way to look at it is whether there is any daylight between the knees during swing through. Cueing to maintain great space between the knees can sometimes help with ITB problems.
      3. Hip strengthening work, particularly the hip abductors. Jason Fitzgerald has put together a good routine for IT band issues here: link to strengthrunning.com

      Hope this helps!

  46. Hi Pete,

    I’ve been running in Nike Free Runs (8 mm drop) for about six months now without any major problem, but in the past few weeks I suddenly started to develop several pains, one of which is ITBS.

    Is it possible that a shoe can still cause injuries after six months of running in them? When I read the comments, everyone seems to have developed their problems after a few weeks of running in the shoes, or even immediately.

    I’m transitioning into zero drop shoes with zero cushioning (or even barefoot), but that takes time and in the meantime I want to try another transitioning shoe.

    Which one do you recommend? Thanks in advance :)

    By the way, I ordered your book Tread lightly. Can’t wait to get started!

    Kind regards from the Netherlands!

  47. Oh, by the way. I’m also seeing a PT and a natural running coach :)

  48. I was glad to find this website with the information. My 12 y o daughter has been having IT band issues for about 5 months now, created and exacerbated by a combination of running and swimming (breaststroke, which is apparently a huge trigger of IT band problems).

    She’s more of a swimmer, and was running for dry land training, but had to quit all of it for awhile this spring due to extreme hip and knee pain.

    She’s been in PT for months now, and has seen an orthopedist as well. The first thing he told us was that her Nike Free running shoes were crap, and we really should have replaced them months ago.

    But we waited until today, and were glad to get rid of them. I was consulting this list while shopping at the sneaker store (Finish Line, where the clerk was almost completely clueless).

    They didn’t have any of the brands mentioned in this article or in the comments, so we went over to Lady Footlocker, which has been bad for us in the past (my daughter has huge feet for a 12 year old, and lots of other foot issues as well). Fortunately there was a new manager there who seemed knowledgeable, and found us a neutral shoe that my daughter said immediately felt great for her feet: Nike Air Pegaus+, with arch support inserts (she pronates terribly).

    It’s been suggested to us that having a young girl wear men’s sneakers, which we originally thought was a good idea (it was hard to find women’s size 10 1/2 in stores, they usually only carry women’s size 10, and 11), that may have helped to lead to problems, since an 11 or 12 year old girl wearing a men’s size 9 1/2 sneaker is still going to have a very different foot and different needs than a teen boy or grown man wearing that size. She hates pink and the girly styles but finally found something that works for her, and now that her feet have grown to women’s size 11 (sigh), it’s easier to find a shoe for her.

    So we are ending PT, but still doing all the exercises, the planking, the foam roller, etc., and I’m going to start taking her to a Pilates trainer who deals with IT band issues for further strengthening and flexibility. Of course NOT covered by insurance.

    We are crossing our fingers about the sneakers and thank everyone here for their comments. Hopefully she will be able to start running again, as well, soon, and swimming longer periods of time.

  49. I came across this post as I was googling more about ITBS. I am a moderate runner (5-10 miles a week) and haven’t had any knee issues before. I don’t know if it’s the shoes, but I started getting knee pain when I run 2-3 miles these days. The pain will go away in 2 -3 days. I recently switched (before the pain started) to Asics gel nimbus 14, which I believe is a cushioned shoe. Someone mentioned in the comments about having knee pain when he use a cushioned shoe. I guess I may have the same problem. Could you recommend any running shoe that has hard base?

    Thanks,
    Priya

    • Is the pain on the side of your knee? If it is ITBS, could be shoes, could be something else that is the cause (e.g., hip strength or running mechanics). Any shoe labeled as a stability shoe should be firmer than the Nimbus. Brooks Adrenaline, Saucony Guide might be shoes to try.

  50. Thanks for this post! I was looking up ITBS and shoes and this came up. I switched from the Ride 4 to the Ride 6 about 2.5 months ago and developed some pain in my right knee (vaguely on the outside though not a stabbing pain). I have given myself lots of rest time between running with the same pain coming back after about 1.5-2 miles. I haven’t gone more than 3 and am not training for everything. I went to our local running store today and had gait analysis. The worker said the neutral shoe *does* seem to be right for me, but I consider it to be like a bad date: everything may look good on paper, but the chemistry is just not there. I purchased a pair of Brooks Ghost 7 and after some icing, foam rolling and maybe a bit of rest this week, I will give the new shoes a shot this weekend and see if the pain is less or gone. Here’s to hoping!

    • Sometimes a shoe change does the trick, here’s hoping it works! Additional things to consider would be having a gait analysis conducted by a therapist to look for hip drop/excessive thigh adduction in which case some strength work and gait cueing might be in order. Also soft tissue work by a skilled therapist might help as well.

  51. I have a 1/2 marathon a week from today. I have been struggling hard with IT band pain for around 4 weeks. I took almost 2 weeks off and wondered about the future of my running, then started using a foam roller and doing exercises that seemed to help some. Long story short the last 2 week have been very hit of miss in terms of ITB pain. This morning I only ran 6 but it was pretty severe. I have been running in Nike Structure 17, then I bought the Structure 18 as soon as they came out last month, but have only worn them twice because I think they make my flare ups worse. I know it is generally a bad idea to change anything this close to a race-but a much as I’m struggling 1 week out, just want your option on changing shoes this late in the game? I will run probably 3 more times this week before the race. Thanks for any advice.

    • Always risky to change this late in the game since you don’t know how a new shoe will treat you. I suppose if nothing else is working, if you can have 3 pain-free runs in a new shoe it may be worth a shot. Really a tough call.

      • Thanks for your reply. I am going to go to my local running store and request a neutral shoe. I have heard they always try to sell you inserts when you tell them that you’re having problems such as mine. I noticed that you named a few of your favorite types of shoes that are more neutral-do you have any current favorites?Just to give me somewhere to start.
        Like you said, it’s worth a try.
        Thanks again

  52. I just wanted to say thanks to Pete and to each one of the abundance of contributors with interesting case studies in the discussion. This might well be the best article/discussion combo addressing ITBS on the internet.

    As for my case, the syndrome was not a surprise, because being used to run up to 5-10 mpw, I ran a relay race totaling 18 miles – when not pounding downhill (naively fast), I ran on the left side of a crowned road – all that in Nike LunarSwifts, more than 750 miles old, the foam of which I only belatedly found to have broken down on the outer side of the heel. Now I am collecting research, trying to find time for abductor strengthening and the MYRTL routine (link to youtu.be), and waiting for the delivery of two pairs of more minimal shoes, the Adidas Adizero Hagio 2 for road and New Balance Minimus 80 for trails.

Speak Your Mind

*