Conditioning: Phase 1

The following is the first of four phases that will guide you from IT Band Syndrome toward healthy running. Progress from each phase as instructed, applying rehabilitation modalities such as taping where needed.

Duration: 1 Week (at least)
Goal: Reduce pain through unloading
Frequency of Exercises: Phases 1a & 1b are twice per day. Phase 1c is once per day. Conditioning should be done without pain. Begin with one of the phases below based on your pain scale.

a. HIGH PAIN

START HERE if pain is >7/10 with squatting and/or running
Goal: Reduce Inflammation. Do not run.

Tape IT Band
Offset Bridge: 3 x 10 reps. Place your injured leg’s foot away from the body. This will decrease load on the affected limb. Bring your hips up and down. If it is too painful on the injured knee, then bring the foot further out or put less pressure on the foot. You should feel your hip and thigh muscles working. Purpose: begin loading glute with mild loading of the knee.
Walking: If minimal or no pain, walk throughout the day in 5-10 minute intervals on a flat surface. Purpose: maintain some loading of the knee.
Calf Stretching: 1 minute per side. Standing with one foot back, place your toes on a half roll or rolled-up towel to increase stretch. Lean forward while keeping your knee straight. Purpose: improve calf mobility to decrease strain on the IT Band.
Ice Massage: 10 minutes. Place ice around the IT Band/knee to reduce pain and inflammation.

b. MODERATE PAIN

START HERE if pain is 4-6/10 with squatting or running
Goal: Continue to reduce pain. Do not run.

Tape: (See video above).
Double Leg Bridges: 3 x 10 reps. Place your legs shoulder width apart with knees bent. Bring your hips up and down. If it is too painful on the injured knee, bring your feet away from your body. Should feel muscles working on the hips and thighs. Purpose: begin glute strengthening to reduce knee caving in.
Clamshells: 3 x 16 reps. Lying on your side with your knees bent (hips to 45 degree angle), bring your top knee up and hold for 3 seconds, then back down. Repeat until 16 reps or fatigue. Should feel muscle work in the hips. You may increase the challenge by adding a resistance band around your knees (recommended). Purpose: strengthen the glutes to reduce knee caving in when running.
Walking: If minimal or no pain with walking, walk throughout the day in 5-10 minute intervals on a flat surface. Purpose: maintain some loading of the knee.
Calf Stretching: 1 minute per side. Standing with one foot back, place your toes on a half roll or rolled up towel to increase stretch. Lean forward while keeping your knee straight. Purpose: improve calf mobility to decrease strain on the IT band. (See video above.)
Ice Massage: 10 minutes. Place ice around the IT Band/knee to reduce pain and inflammation.

c. MILD PAIN

START HERE if pain is < 3/10 with squatting and/or running
Goal: No pain with activity. No running.

Single Leg Glute Bridges: 3 x 8 reps. On your back with one knee up. Bring hips up and down slowly. You should feel muscle work on the thigh and hips. Purpose: increase demand on glute muscles to reduce risk of knee caving in.
Rose Hips: 3 x 12-16 reps. On your side with your body straight, bring your lower leg up for stability. Your top leg, with toes biased downward, goes up and down slowly to recruit muscles on the side of your hip. Be careful not to let your top hip come forward (easiest to do this along a wall to prevent compensation). Purpose: increase hip strength to reduce knee caving in.
Clamshells: 3 x 16 reps. Lying on your side with your knees bent (hips to 45 degree angle), bring your top knee up and hold for 3 seconds, then back down. Repeat until 16 reps or fatigue. Should feel muscle work in the hips. You may increase the challenge by adding a resistance band around your knees (recommended). Purpose: strengthen the glutes to reduce knee caving in when running. (See video above.)
Single Leg Balance: 3 x 30 seconds (each leg). Ideally, complete this in front of a mirror. Stand with both hands on your hips while your feet are directly under you. Keeping your pelvis as stable as possible, bring one leg up without causing your pelvis to tilt or rotate. Hold that position. Purpose: improve hip, knee, and ankle joints stability.

Stretching:
- Calves: 1 minute per side. Standing with one foot back, place your toes on a half roll or rolled up towel to increase stretch. Lean forward while keeping your knee straight. Purpose: improve calf mobility to decrease strain on the IT band.
- Quads: With one leg on the table/couch/bed, the other leg is off the table. Grab a belt or two (or Resistance Strap) and hook one end on your foot that is on the table. With your body aligned up straight, begin to pull your heel towards your hips until you feel a moderate stretch in the front of the thigh. Hold for at least one minute. If pain increases, place a towel under your thigh to pre-stretch the quad.
- Hip Flexors: In the kneeling position with your arms supported on the wall, engage your abdominals by doing a posterior pelvic tilt (i.e. low back is flattened with a limited curve). Engage your glutes on your kneeling side and keep your body as a unit until you feel a stretch in the front of your hip. You may increase your stretch by leaning away from the side.
Walking and/or Biking: Light resistance (raised seat), very slight discomfort okay.
Ice Massage: 10 minutes. Place ice around the IT Band/knee to reduce pain and inflammation.

TO GRADUATE TO PHASE 2
Spent at least 1 week in this phase, and the following have been met for at least 3 consecutive exercise sessions:

Required: Pain is <3/10 at worst; and when aggravated, pain does not linger for >1 minute
Required: Can do a squat with very mild pain (<3/10) and walk with no pain
Required: Can sleep without waking up from pain in the knee
Note: If you begin at Phase 1.a., before graduating to Phase 2, be sure to progress in turn through Phases 1.b. and 1.c.

Principles of IT Band Syndrome: A Review

CAUSE – overuse with increased compression forces
NEED – strengthen glutes and reduce quad/IT band tension
PLAN – offload IT Band, gradually reloading it per pain tolerance

Still Need Help?

You are welcome to meet virtually with our PT for additional feedback and assessment. Otherwise, continue to the next step to learn how best to manage the pain from your injury.