This document was originally published as a much simpler article in 2002. It was expanded and republished as a book-length tutorial in April of 2007, and has been updated and revised regularly since then. An unusually large batch of improvements were made in mid-2012 in preparation for recording an audiobook.
A major feature of my tutorials is that I actively update them as new science and information becomes available. Unlike regular books, and even ebooks — which can be obsolete by the time they are published, and can go years between editions — this tutorial is updated at least once every three months and often much more. I also log updates, making it easy for readers to see what’s changed. This tutorial has gotten 63 major and minor updates worth logging since I started logging carefully in late 2009, and countless more minor tweaks and touch-ups.
New item (Sep 23 '14, section #5.26) — A brief but very well-researched review of platelet-rich plasma injection. See section #5.26, Brief debunkery of several therapies that you should be particularly skeptical of.
Updated (Apr 1 '14, section #3.1) — Added good news story from a reader about a case with a cyst, and improved the information about cysts at the same time. See section #3.1, Should you get an MRI?
Major update (Jan 30 '14) — The first complete professional editing of this book has now been completed. Although the difference will not be obvious to most readers, several hundred improvements and corrections were made, and it is definitely a smoother read.
Science update (Nov 21 '13, section #5.20) — Added a bad-news citation. Sorry about that. See section #5.20, Soft knee straps (and/or Kinesio Taping) are worth a shot.
New case study (Oct 3 '13, section #2.8) — Added a fascinating and extreme example of the effect of running style from a case study of an ultra-runner. See section #2.8, Why does IT band pain gets so nasty so fast? A vicious cycle related to running pace.
Science update (Jul 9 '13, section #2.10) — A particularly “good news” science update about how running is, counterintuitively, actually pretty good for joints — not hard on them. See section #2.10, “Maybe you’re just not built for running”.
Update (Jun 13 '13, section #2.10) — A new introduction for the chapter about the trend of anti-running “science.” See section #2.10, “Maybe you’re just not built for running”.
Updated (May 29 '13, section #2.14) — Added more detail and a couple examples. See section #2.14, When ITBS isn’t a repetitive strain injury.
Minor update (Apr 10 '13, section #2.10) — Minor but nice: a really good new quote adds some entertaining and genuinely fascinating perspective to this section. See section #2.10, “Maybe you’re just not built for running”.
Minor update (Mar 29 '13, section #5.5) — Upgraded risk and safety information about Voltaren Gel. See section #5.5, Ibuprofen and friends: non-steroidal anti-inflammatory drugs (NSAIDs), especially Voltaren® Gel.
Product upgrade (Feb 4 '13) — Audiobook version now available. See the announcement for more information.
Minor update (Dec 7 '12, section #2.3) — Added some fun stuff and context about bad anatomy. See section #2.3, So is it a tendon or what? IT bands are special.
Expanded (Nov 29 '12, section #5.14) — Added much more detailed self-help information for trigger points. See section #5.14, Trigger point massage for your hips, glutes & quads.
Science update (Nov 20 '12, section #5.22) — Weak but interesting new evidence on natural running and injury prevention. See section #5.22, Should you run naked? On faddish running styles and running shoes (or the lack thereof).
Science update (Nov 13 '12, section #5.12) — Added evidence from the first foam rolling research ever done. See section #5.12, IT band massage, foam rollers, and Graston Technique® — a big fat waste of time and/or money.
Major update (Nov 9 '12, section #5.15) — Numerous significant clarifications, revisions, and new references, and a generally stronger recommendation. See section #5.15, Deep transverse friction massage.
Rewritten (Oct 18 '12, section #6) — Now about four times more detailed than before and much more strongly focussed on the positive, what my final recommendations are, and how to “put it all together.” See section #6, Now what?: An action-oriented summary of recommendations.
Nice upgrade (Oct 17 '12, section #5.18) — After years of procrastination, I have finally created a video demonstration of a tricky ITBS stretch! About time! See section #5.18, Some stretching hope: a better iliotibial stretch?
New section (Oct 17 '12, section #5.1) — New standard section I’m introducing to most of the tutorials to “manage expectations.” Too many readers assume there’s going to be a specific miracle treatment plan. See section #5.1, So what’s the plan?
New diagram (Jun 30 '12, section #5.14) — Nice new diagram, “Key locations for massage treatment of ITBS.” See section #5.14, Trigger point massage for your hips, glutes & quads.
Minor update (May 4 '12, section #5.9) — Very simple swimming tip added. Hat tip to reader Eric C. See section #5.9, The fear of rest, and relative resting: how to maintain fitness while protecting your knees.
Major update (Mar 12 '12, section #5.21) — Rewritten and expanded, much clearer and more detailed. Not much new science, though — ITBS+orthotics science is pretty scarce! See section #5.21, Orthotics for IT band syndrome: a worthwhile long shot.
Minor update (Mar 8 '12, section #5.9) — Added a paragraph about elliptical machines. See section #5.9, The fear of rest, and relative resting: how to maintain fitness while protecting your knees.
Minor update (Mar 8 '12, section #5.3) — Added an example of surgery gone wrong. See section #5.3, The old surgery: snipping the band.
New section (Mar 8 '12, section #2.14) — No notes. Just a new section. See section #2.14, When ITBS isn’t a repetitive strain injury.
Revised (Feb 27 '12, section #5.15) — Some modernization and clarifications. Now also discusses the notion of “just rubbing” the hot spot. See section #5.15, Deep transverse friction massage.
Rewritten (Feb 18 '12, section #5.8) — Another “like new” rewrite: this section now offers much more detailed resting advice, perspective, and troubleshooting. See section #5.8, The art of rest: the challenge and the opportunity for patients who have supposedly “tried everything”.
Rewritten (Feb 16 '12, section #5.7) — This section is “like new” and much beefier, and links to an upgraded main contrasting article as well. See section #5.7, Contrast hydrotherapy: exercising tissues with quick temperature changes.
Rewritten (Jan 23 '12, section #5.2) — Major changes: new science, new recommendations, more detail, and some explanation of the (very difficult) problem of why anti-inflammatory injections might work despite the fact that IT band syndrome doesn’t involve much inflammation. See section #5.2, Steroid injections: a complicated mix of certain risks and uncertain rewards.
Rewritten (Jan 16 '12, section #5.6) — Completely revised to reflect new science and new understanding of the interaction of ice with “inflammation.” See section #5.6, Icing: more is better?
Rewritten (Jan 16 '12, section #5.5) — Completely revised to reflect new science and new understanding of the interaction of NSAIDs with “inflammation.” See section #5.5, Ibuprofen and friends: non-steroidal anti-inflammatory drugs (NSAIDs), especially Voltaren® Gel.
Major Update (Jan 13 '12, section #5) — Expanded and revised summary of treatment options, with emphasis on new and better recommendations about “anti-inflammatory” treatments. See section #5, Treatment: What can you do about iliotibial band syndrome?
Updated (Jan 11 '12, section #4.3) — Advice on “running through” has changed, with more emphasis on the unknown but plausible risk of permanent damage. See section #4.3, Can you “run through” iliotibial band syndrome?
Major revision (Jan 11 '12, section #2.11) — Extensive editing and re-writing concerning the nature of inflammation. The main point of the section remains unchanged, but the section now does a much better job of explaining why ITBS isn’t really inflamed, and why it matters. Although not cited, this update drew heavily on some new scientific papers. See section #2.11, Where’s the fire? The inflammation myth.
Updated (Dec 29 '11, section #5.4) — Added new information and some pie charts about the success rate of arthroscopic surgery for ITBS. See section #5.4, The new surgery: excision of tissue from under the IT band.
Minor update (Dec 13 '11, section #5.8) — Addressed some common fears about the threat of getting out of shape while resting. See section #5.8, The art of rest: the challenge and the opportunity for patients who have supposedly “tried everything”.
Trivial update (Nov 25 '11, section #1.3) — Added an example of unusually bad ITBS information, made widely available. See section #1.3, How can you trust this information?
Major update (Nov 23 '11) — Clearer and more thorough content throughout several sections about the “Nature of the Beast” and “Diagnosis,” especially from the discussion of root causes and onwards. I am producing the audio version of this tutorial, and I am revising and improving content significantly as I go. Information about trigger points was completely re-written, and there’s a whole new section about hip and thigh pain.
Updated (Nov 16 '11, section #5.19) — Modernization and revision for clarity. See section #5.19, Mobilize and stretch the hip musculature.
New section (Nov 16 '11, section #5.17) — Stretching is such a hot topic that I decided to break the discussion up with a new section focussed on stretching the IT band itself. It was inspired by important new scientific evidence: researchers have found that IT band stretching is not a very moving experience… See section #5.17, The trouble with stretching the IT band in particular.
Major update (Nov 15 '11, section #5.18) — Significant modernization and clarifications. Much better description of why this kind of stretch might be worth trying. See section #5.18, Some stretching hope: a better iliotibial stretch?
New science (Nov 15 '11, section #2.3) — Added more anatomical evidence that the IT band is particularly impossible to stretch or even move. See section #2.3, So is it a tendon or what? IT bands are special.
New section (Nov 10 '11, section #2.13) — No notes. Just a new section. See section #2.13, Hip and thigh pain: part of the problem, or red herring?
Minor update (Nov 10 '11, section #1.5) — Clarifications about the location of IT band syndrome pain. See section #1.5, Are you in the right place? Patellofemoral versus IT band.
Updated (Nov 2 '11, section #5.16) — Added new research evidence that stretching doesn’t prevent injuries, including (of course) ITBS. See section #5.16, Stretching to prevent or treat IT band syndrome.
New video (Oct 14 '11, section #1.1) — Section now includes a new video, summarizing myths and treatment mistakes. See section #1.1, Ineffective therapies for IT Band syndrome are common.
Minor update (Sep 28 '11, section #5.23) — Added reference to Kong et al, about the effect of shoe wear. See section #5.23, Running softly and the impact of impact.
Minor update (Jul 29 '11, section #1) — Added a reference about the poor overall quality of online information about common injuries. See Starman. See section #1, Introduction.
Rewritten (Jun 17 '11, section #5.23) — Evidence about the real but surprisingly weak connection between impact forces and injury from Zadpoor et al has prompted a bunch of revision and new recommendations for runners. See section #5.23, Running softly and the impact of impact.
Major update (Jun 15 '11) — Major improvements to the table of contents, and the display of information about updates like this one. Sections now have numbers for easier reference and bookmarking. The structure of the document has really been cleaned up in general, making it significantly easier for me to update the tutorial — which will translate into more good content for readers. Care for more detail? Really? Here’s the full announcement.
New section (Apr 28 '11, section #5.13) — No notes. Just a new section. See section #5.13, Mis-treatment horror story: intense massage on an obviously inflamed thigh.
New section (Feb 20 '11, section #5.22) — Finally, long overdue, a new section on this topic. See section #5.22, Should you run naked? On faddish running styles and running shoes (or the lack thereof).
Important new info (Feb 8 '11) — Where’s the fire? Recently I published a major new article about repetitive strain injuries (like IT band pain), in which I explain that these injuries are rarely actually inflamed. Instead of being “on fire,” excessively stressed tissues tend to break down without inflammation — a kind of rot. For the full scoop on inflammation and repetitive strain injuries, see: Repetitive Strain Injuries Tutorial: Five surprising and important facts about repetitive strain injuries like carpal tunnel syndrome, tendinitis, or iliotibial band syndrome.
New section (Dec 2 '10, section #3.10) — New short section for both this book and the patellofemoral pain book covering potentially confusing alternative diagnoses, such as politeal artery entrapment syndrome (PAES). See section #3.10, Other possible diagnoses and sources of diagnostic confusion.
Overhauled (Sep 15 '10, section #2.7) — Rewrote section to accommodate some new science. The new evidence is interesting, but not particularly illuminating: it mostly just emphasizes how we really (still) don’t know if IT band tightness is actually a problem. See section #2.7, Like a rock in your shoe: the mechanism of irritation and the red herring of tightness.
New cover (Aug 6 '10) — At last! This e-book finally has a “cover.”
Minor update (Jul 27 '10, section #5.26) — Updated the nutraceuticals item with information about a new study of glucosamine for knee pain. See section #5.26, Brief debunkery of several therapies that you should be particularly skeptical of.
New section (Feb 12 '10, section #7.2) — One of several new/revised sections based on the implications of a new surgical technique (see Michels et al). See section #7.2, Appendix B: List of surgeons offering arthroscopic repair of iliotibial band syndrome.
New section (Feb 12 '10, section #5.4) — One of several new/revised sections based on the implications of a new surgical technique (see Michels et al). See section #5.4, The new surgery: excision of tissue from under the IT band.
Major update (Feb 12 '10, section #5.3) — One of several new/revised sections based on the implications of a new surgical technique (see Michels et al). See section #5.3, The old surgery: snipping the band.
New section (Feb 12 '10, section #2.6) — One of several new/revised sections based on the implications of a new surgical technique (see Michels et al). See section #2.6, The bursitis possibility.
Major update (Feb 12 '10, section #2.5) — One of several new/revised sections based on the implications of a new surgical technique (see Michels et al). See section #2.5, A new surgery works without loosening anything tight.
Major update (Feb 12 '10, section #2.4) — One of several new/revised sections based on the implications of a new surgical technique (see Michels et al). See section #2.4, What’s actually irritated? Not the IT band ….
And many more (May '07 – Dec '09) — Thirty-five older updates are listed in a separate document, for anyone who cares to take a look.