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How to strengthen your iliotibial bands
To truly strengthen your ITB area, simply perform 'Walt Reynolds's ITB Special' on a nearly daily basis. Walt's ITB-saver is easy to carry out. The only equipment you'll need will be a wall or railing for support and some kind of four- to six-inch elevation (a bench or aerobic step will work fine).

Here's exactly what to do. Stand on the aerobic step or bench with your involved leg (the 'involved' leg is the one with the ITB problem), holding on to a rail or the wall with the opposite hand for support. Your legs should be fairly straight as you do this.

Now, with both knees 'locked,' lower the opposite, non-involved foot and hip a few inches toward the floor (of course, the non-involved leg is between the involved leg and the wall you are using for support. As you do so, your involved hip will move upward somewhat, so that it is actually higher than the non-involved hip. Your involved hip should also move a bit in a lateral direction (toward the outside). This 'swivel-hip' action is crucial to the exercise - and in fact is exactly what happens to the hips during the 'stance' phase of the gait cycle.

Next, attempt to shift most of your body weight to the inside part of the foot of the involved leg. This simulates the natural pronation of the foot which occurs during running, and it also engages and puts tension on your tensor fascia lata and iliotibial band, exactly as it would when you run. Make sure that a fair amount of your body weight is directed through your heel, not just your toes.

You've now come to a crucial part of the exercise. Bend your weight-supporting, involved knee slightly (about 10 to 20 degrees), but keep the non-involved foot off the ground or floor. Now, move the involved hip forward about four to six inches, while keeping the involved heel in contact with the step and your weight on the inside of your involved foot. As you do this, all of the action should be at the hip! Your knee angle should stay about the same throughout the exercise (eg, don't try to rock forward at the knee - do it from the hip). If you think of your pelvic girdle as a bowl of milk, that 'bowl' is rocking backward (ie, the bottom of the bowl is coming up and toward the front as the top of the bowl goes back slightly). As your involved hip moves forward, your upper body should move backward.

Very key points: as your involved hip moves forward, make sure that it stays in a lateral position (if it's your left hip, your left hip should be shifted to the left), and also be certain that your involved hip is higher than your non-involved hip. After you've moved your hip forward, move it straight backward - making sure it goes back four to six inches beyond the straight-up, starting position (the total hip-movement distance in this exercise is around eight to 12 inches, four to six inches toward the front and four to six inches back).

As your hip moves backward, your upper body will tend to bend forward. This action may seem strange to you, especially when you realize that in effect your hip is swinging back and forth over your foot in two different planes of motion - front to back (the sagittal plane) and also sideways (the frontal plane). Most runners envision the biomechanics of running quite differently - and tend to think that the key action during running is the swinging of the foot back and forth around the 'anchor point' of the hip.

However, the truth is that when the foot is on the ground, the foot is the anchor point, and the hip essentially rotates around the foot, not vice-versa. It's this action which puts mega-stress on the ITB, and that's why Walt has rather brilliantly designed this exercise to mimic the hip rotation involved in running and maximally fortify your iliotibial bands. It is this same back-and-forth motion which occurs 85 to 90 times per minute at each hip when you run - and which can turn one of your iliotibial bands into a tattered, complaining mass of red-hot tissue.

As you do the exercise, you should feel the burn - or if not the burn at least some pretty heavy-duty pulling and stress - up toward the side of your hip. If you don't feel anything happening, go back to the basic position and try again, making sure that your involved hip ends up in a lateral position and higher than the other hip - and also making certain that your weight is shifted to the inside of the involved foot. As your weight shifts to the inside of the foot and your hip moves laterally, your thigh is adducted, exactly as it is when you run, and your iliotibial band must work hard to control this adduction as your hip moves back and forth.

Try these advanced versions
Once you get really good at doing the exercise, you can try the advanced versions of Walt's Special, getting the arm on the involved side of the body into the act.

First, move the involved arm laterally and forward as your hips swing forward. Then, try moving the involved arm forward and over the front of the body as the hips begin to swing forward.

Of course, if your ITBS is red-hot right now, you'll have to wait a bit before you try Walt's Special. Otherwise, the remedial exercise itself might exacerbate your flare-up. If you're on the road to recovery from an ITBS setback, do the exercise as your symptoms allow, being careful not to overextend your iliotibial bands (start with just a few reps).

If you're basically symptom-free now but have had trouble with ITBS in the past, you can be fairly aggressive with this exercise. Start with 10 reps per day on each leg, and gradually build up to a set of 20 to 30 reps - carried out at two different times during the day. If you do so, your ITBS problems will become distant memories.

If you've never suffered from the agony of ITBS, do 10 to 15 reps of the exercise three to four times per week, anyway. And always use the exercise as an injury prophylactic during the weeks leading up to a major increase in your training (remember that ITBS tends to occur when the volume and/or intensity of training increase).

For example, if you are in a 'base' period of training but are planning to sharply increase your miles as you begin preparing, say, for a marathon, do at least one set of 15 reps of Walt's Special twice per day on each leg during the last three weeks before your training volume begins to rise significantly (this should be done almost daily). The same would apply to a shift from high-volume, 'aerobic' running to an emphasis on speed work.

Walt's unique exercise will keep you out of ITBS trouble in the future; as it bolsters your iliotibial bands, it will enhance your ability to control the adduction and rotation of your thigh bones (femurs) during running, reducing both fatigue and muscle soreness. As you gain greater control of your hips and thighs, there's also a good chance that your running economy will improve. Remember that you do not want to carry out the exercise only on the leg which has given (or is giving) you trouble. To balance your strength properly, do the same number of reps on each leg, even though one leg may be trouble-free.

Special risk factors
If you love to run on crowned roads, watch out! You are at increased risk for ITBS, compared to the runner who prefers flat surfaces, and your ITB troubles are likely to strike on the 'down' leg, the one positioned toward the outside of the road. That's why runners who run with the traffic tend to have ITB troubles in their right leg; those who run against traffic get the flare-ups in their left appendage. The reason for this, of course, is that the outside foot and leg are moving downward at a faster speed when they strike the pavement, compared to the inside foot and leg, because they have fallen a slightly greater distance. It's as though the outside leg is always running downhill. Thus, the total force on the outside leg will be greater, and there will be an increased need for 'thigh deceleration' by the tensor fascia lata and its associated iliotibial band. The tensor fascia lata will be shortening and generating more force at the same time that the 'pull' on it is unusually great. That's a recipe for injury! It's best to get off the 'crown' and run on the usually flatter shoulder - or else to choose a different, non-sloped location for your workouts.

It's an unwritten law of the universe that runners must run on a track counter-clockwise (anti-clockwise), rather than clockwise. This means that for the person who trains excessively on the track, ITBS will almost always strike in the left (inside) leg, because the left tensor fascia lata and its bands must control a greater deceleration of adduction than the right (outside) hip.

As Walt Reynolds puts it so eloquently, 'When a person runs on a curve to the left, he/she will compensate for the outward-pushing centrifugal force by leaning slightly to the left. The faster they run, the greater the lean must be (that's why very fast track sessions pose an increased risk for ITBS). You see the same thing in flop high jumpers' approach runs; they run fast and lean far to the inside - toward the bar. This lean with the upper torso can drastically change what happens biomechanically. As you lean into a left curve and your left foot hits the ground, pronation is exaggerated compared to running straight ahead, since the left foot tends to land more toward the outside and thus must roll to the inside to a greater extent than usual (there is more frontal-plane - side-to-side - movement than usually occurs). As this happens, the left thigh accelerates inward (adducts) to a greater extent than normal, creating a need for greater deceleration than usual by the iliotibial band and stressing the ITB considerably more, compared to running straight ahead. If you must run on the track, you should alternate back and forth between clockwise and counter-clockwise intervals.'

Get a longer leg!
Having a leg-length discrepancy also increases the risk of ITBS. When the two legs are unequal in length, the shorter leg receives greater stress in much the same way that the outside leg takes in more force during running on a crowned road. The momentum and ground reaction forces are higher for the shorter leg because that leg falls a greater distance before the foot makes impact with the ground. This increases ankle pronation and thigh-bone adduction - and thus the stress placed on the iliotibial band.

Women should suffer from ITBS more frequently than men, since their wider hips promote greater thigh-bone adduction and thus greater stress on the ITB. However, the research doesn't support this idea - and in fact suggests that men may actually be plagued by ITBS more often, perhaps because of their greater muscle tightness and inflexibility.

Speaking of inflexibility, it's important to stress once again that traditional stretches don't work very well at preventing or relieving ITBS. In one of the most popular ITB stretches, if the right leg is the afflicted leg, the left leg is crossed over in front of the right one, and the upper body is inclined to the right (a wall is usually used for support), placing a fair amount of stretch on the right iliotibial band.

One problem with this 'venerable' move is that it is not very functional (it doesn't replicate the movement patterns associated with running), but the other key drawback is that it does not strengthen or increase the resiliency of the ITB. It gives the ITB a little bit of a pull, but the tensor fascia lata and its associated bands don't have to control a blessed thing. The best exercises always bolster both flexibility and strength, and Walt's special exertion certainly does that!

If you've already got a severe case of ITBS, stay in shape by swimming and aquarunning: they will keep you fit without aggravating your condition. Cycling and stair climbing are usually out, because they can produce considerable rubbing of an inflamed ITB band on the outer edge of the femur, potentially delaying recovery.

Owen Anderson (text) and Walt Reynolds (exercise)


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