How to Continue Marathon Training Despite IT Band Issues

Last week, Becky from Olives and Wine had some IT band issues, and blogged about how disappointing it was that her knee pain was interrupting her training for her first marathon. Like many first time marathoners, she wanted to find a way to push on in spite of her injury. Having suffered my own IT band issues early in my 50 state marathon quest, I could sympathize completely with what she was going through. It sucks to have your knee act up while you’re running! Fortunately, I had a few ideas for her to be able to keep going – and when a few others asked for more details, I decided it might be worth a blog post of its own.

How To Continue Marathon Training Despite IT Band Issues

Please note that while I have a RRCA coaching certification, I am not a doctor. I would strongly encourage you to discuss your training plans with your doctor for approval before continuing to run with an injury.

So first, some background. The iliotibial band (IT band or ITB) basically runs from your butt down to your knee, adjusting as the leg bends and straightens. It helps to stabilize the knee, which is why if it’s not working properly, you end up with knee pain. Inflammation of the IT band occurs a lot in distance runners, mostly because of overuse. Cambered roads can be especially problematic in causing IT band injuries, since one leg ends up being downhill of the other while you’re running, throwing off the body’s natural balance. Generally, IT band tightness is caused by weak hip and butt muscles; meanwhile, weak quads can contribute to Runner’s Knee (another common source of training injuries). You can guard against both of these by lifting weights diligently and keeping your muscles strong.

Pain, in general, is your body’s way of telling you that something is wrong – so it’s never wise to just ignore it. However, IT band issues can be as severe as sharp pain in the knee, or as mild as some slight tension and tightness. If what you’re experiencing is closer to the latter, I definitely understand the motivation to just run through it and not give up on your marathon dreams! If it’s the former, you may be able to heal it to just the latter by resting for a week or so and then starting this protocol from there – but I’d strongly encourage you to both see a doctor and also consider putting your marathon plans on hold for a season if the pain is really that severe.

The first step is getting through the tightness is make sure to start stretching out that pesky IT band – here’s a fantastic article on the best stretch for the IT band, as well as a whole lot of background on what the IT band is and does. You can learn a ton from that article!

Next, get ready to make your foam roller your best friend. Foam rolling is less effective when you do it all at once, so you’ll need to do it frequently if possible, though each session doesn’t need to be long. Consider rolling for five minutes in the morning when you wake up, another five minutes after any long periods of sitting (like right when you get home if you work at a desk job), another five minutes after any kind of workout, and one final session right before you go to bed.

To target the IT band, lie on your side on top of the foam roller, with the roller at your hip. (I find that’s less painful than starting with the roller at your knee.) Very slowly start to roll so the roller is moving down your leg toward your knee. Now here comes the crappy part: whenever you get pain from hitting a tight spot, stop rolling and hold that position until the pain subsides a bit. It’s going to hurt, I know, but that pressure is ultimately helping to relax the muscle. Make sure that you are supporting some of your weight on your hands while doing this, and move more weight from your leg into your hands to lessen the pressure as needed. You should feel uncomfortable, but not in severe pain! The more you do this, the looser that IT band will get – and eventually, it will loosen enough to where its able to do its job and protect/stabilize your knee. For more on foam rolling, check out this awesome DailyBurn article by Christine.

So… what about running? All the foam rolling in the world is not going to train you to run a marathon – it just loosens up the muscles and IT band so that you are able to train. However, your training protocol will be very different than usual if you experience IT band issues during your marathon training cycle.

If you’re having knee issues of any kind, the last thing you want to do is keep pounding away on a hard surface. You want to lessen the impact as much as you can, so you’re going to cut back on your running schedule to ideally only be running two days per week. And those days are going to be short runs of fewer than 6 miles, ideally on dirt/grass/another soft surface.  You’ll probably have a natural inclination to make these runs fast, since the distance is short, but these should actually be at long run pace.

What about your long run, though? Running a marathon definitely requires a lot of endurance, and that gets built up over time. Even if you were already doing 20 milers before you developed the IT band issues, you’ll need to keep it up if your marathon is more than a few weeks away. So, move your long runs from pounding the pavement to circling the elliptical machine at the gym. To figure out how long to go, convert your long runs from miles to minutes at your old long run pace – so if you were a 10 minute miler and scheduled to run 18 miles, do three hours (180 minutes… ugh, I know) on the elliptical.

One critical thing to note: since the elliptical picks up momentum in a way that regular running doesn’t, you’ll need to be diligent about making sure your heart rate still hits workout levels. With long runs, you can usually relax and not worry too much about your pace, but when you’re doing a simulated long run on the elliptical, you’ll need to periodically check in and refocus to ensure that you’re working as hard as you would while running.

By combining the short actual runs with the simulated long runs on the elliptical, you’ll keep your muscles in “I know how to run” shape and also get your cardiovascular system up to the endurance challenge, but minimize pain/injury from running. This strategy is not going to get you to run the fastest marathon of your life; rather, it’s meant for those who simply must complete 26.2 miles even after they’ve been injured. If you’re choosing to run the marathon anyway, remember that you will likely be in pain during your marathon, and will be whenever you run long distances until you’ve actually resolved the source of the issue. (Please, take a break and do that!) However, if you are bound and determined to run no matter what, rest as much as possible the week before your goal race (switching even the short runs over to the elliptical), and minimize pain until you can’t put it off any longer (the actual race). Post-race, it’s back to that foam roller to loosen the IT band you’ve probably once again tightened.

Anyone else tried this approach, or any tips to add? From the comments on Becky’s post, there are a lot of people who’ve been saddled with this injury!

Comments

  1. Thank you SO much for posting this, Laura! You’re seriously a lifesaver. I did the elliptical trick earlier this week and it worked like a charm. I’m planning on attempting a short run today – fingers crossed! Also, I’m totally sharing this on my blog later today :) It’s going to help so many fellow runner!
    Becky @ Olives n Wine recently posted…SYS – What is it?My Profile

  2. Thank you for this post! It’s nearly 4 am and I’m awake worried about how I’m going to finish training for my half marathon that is less than a month away. My IT band has me in an incredible amount of pain. After reading your post, I’ve developed an action plan…1. Doctor (this is a big deal! I very rarely go, so if I am going, you know the pain is unbearable) 2. Rest, roll, repeat 3. Elliptical (good thing I’m a morning person, because I think I’m going to be spending some serious time of that machine).

    You’ve given me a bit of hope that I’ll still be able to finish my training and run this race. Thank you!

  3. Thank you for this! I am only feeling pain in mile 12/13 of my long runs and my marathon is only 2 weeks away! I have run up to 17 miles but not longer than that because of the pain. Any suggestions for getting myself ready? Is 17 miles enough?

    • With two weeks to go, your priority should just be rest (and elliptical) rather than trying to do a longer distance – which may just tighten you up for the race. Your best bet at this point is to take it easy, and then just be prepared for a big slowdown late in the race. You may be walking more than you originally would have liked, but you can still finish!

      Which marathon are you doing?

  4. Thanks for this great post Laura – I’ve been googling “IT band pain marathon”, with my first marathon in 7 days time.
    I’ve run a couple of 20-milers recently and had pain on the outside of my right knee after about 15 miles, but worryingly went for a light 8 mile run today and felt it start after just 5-6 miles. Currently have ice on my knee, and will try stretching/foam-rollering and a slow, short run in a couple of days (unless I can find an elliptical trainer). Any other suggestions to help get through the race? Maybe an IT band strap?

    • Honestly, before my IT band issues cleared up for good, that was a little bit similar to how mine was – pain would start somewhere in the 5-10 mile range, and so I’d walk a lot to avoid aggravating it. It’s not exactly the way to a fast time :( Also, I’ve never tried a strap myself so can’t say one way or the other whether that would help! But YES to ice and foam rolling. If your marathon is a week away, I would skip all running and just rest as much as possible – you’re not going to lose fitness in just a week, but you could absolutely aggravate it.

      Which race are you running? Good luck!

  5. Thanks, race is Bristol-Bath (UK). I’ll skip the run and try and use an elliptical trainer for a session, someone else recommended this also.

  6. Thanks! This is helpful. I have my first half in about 4 weeks and just started having IT band issues. I still wanted to get some longer runs in (I have run up to 10 but that was about 4 weeks ago) and having trouble figuring out what my training plan should be. I also started dry needling this week to help.

  7. Laura, How often can I roll?

  8. Hi Laura, thanks for the great post!

    I had IT band issues for two months and progress has not been good. I’ve stopped running for the past 6 weeks and visited a physiotherapist. She taught me some home stretching exercises which at times cause the IT band to feel more achy after a day or two.
    Do you have any advice for me please?

    She also recommended the rolling pin method. Is that more effective than the foam roller?

    I’m desperately wanting to recover n get back to running… I’m suffering from the injury runner’s blues!

    Thanks!

    • I’m so sorry to hear about your ITB issues! Using a rolling pin will be more painful than a foam roller, but also more effective – since you’re using a harder object, it will dig into the muscles/bands more. I think the biggest thing that will help, unfortunately, is rest (and also doing strength training to prevent the ITB issues from coming back). Have you tried the elliptical as an alternative while you can’t run?

    • Thank you Laura for the prompt reply..

      My PT advised me not to do the elliptical as it would hurt the knees. I read that injured runners turn to the elliptical too. Thus, to play safe, I am staying away from it.

      However, I try to maintain my fitness by swimming. Much less regularly than the frequency I was running.. Thus, I am facing weight gain issues too :(
      I don’t know how long it will take to recover.. and when I can get back to running..
      I feel depressed and am thinking about this all day long.

  9. Dear Laura,

    There seem to be mixed reviews of foam rolling the IT band. A quick google search will reveal websites that states foam rolling the IT band causes more harm than help.. May I find out what is your take on this? I am desperately trying to foam roll my IT band injury away, but the slow recovery process plus reading anti-foam roll articles is making me very confused and lost.
    Please help!

    Thank you so much!

    • Thank you for this post! My marathon is 3.5 weeks away. I did an 18 on saturday. I’ve never had any IT pain (during this training period)previous to that. It hit at mile 17. You said this method won’t get you a fast time. Is it possible to still hold up my endurance enough to get a good time? I was on track to qualify for boston and i know i can if i can keep the ITB pain away. Is cycling for cross training good too if your heart rate is high with fast rpms? Any advice would be appreciated. Thank you!

    • I think your endurance will be okay (particularly if you can transition your long runs to the elliptical), but three weeks might be a bit of a stretch for speed if you aren’t running. As you mentioned, I would definitely encourage you to mix in some high heart rate training, whether on the bike or on the elliptical – that will definitely help!

    • Argh, I’m sorry to miss this earlier! How is the recovery going? I do agree that foam rolling can cause more harm if you overdo it, but I am in the camp that a few minutes at a time is probably good for it.

  10. Steven Wood says:

    Thanks for this article – i also have my first marathon in 3 weeks time, my long runs for the last 3 weeks have been cut short at about 15 miles as the pain on the outside of my left knee is too much to continue. Strangely it seems absolutely fine when i go for a quick 5 mile run but on the long run i feel it start to get sore about that point gradually getting worse until the point where i need to stop. It didn’t start to get sore until my first long run and then it happened at mile 13 and now each long run – it comes back. Frustratingly i feel like by the end of the long run I haven’t been able to push much at all and am hardly even sweating as the pace is so slow, the only discomfort is in my knee. I’m going to go for short runs and keep the exercises going and see what happens on the day, expecting the 2nd half to be a real struggle with a painful knee sadly :(

    • So sorry to hear about your pain, Steven! Have you tried foam rolling yet – did that have any effect? Sounds like you have the best plan possible under the circumstances!

    • Thanks Laura.

      I do not know if I will ever recover.

      I am very baffled as to why IT band injuries take so long to heal, or seem to never heal, even with ample rest.

      I have never made an effort to strengthen my glutes/ hamstrings/ quads in the past, and I could complete half marathons (2 in 2 months). Yet, doing these strengthening exercises now cannot seem to help get my knee fully recover.

      Am really upset with my slow recovery to the point that I suspect I may never make a full recovery and be able to run the same as before….

      Pardon my pessimism please!

    • Grace, I am so sorry to hear the update – and of course I understand your pessimism! Don’t give up hope, though – it seems to me that IT band injuries can come on at random as well, so perhaps it will go away after more time.

    • Hi! I am struggling with the same thing…I’m in week 5 of PT and IT band issues still persist. I was training for my first marathon and now so bummed just thinking of not being able to run it. I am going to try acupuncture in addition to PT to see if that works. I’ve also started looking into essential oils that help with inflammation and well as other herbal supplements- hopefully something works. The Chicago marathon is about 6 weeks away and I’m not sure if running it is still in the picture :/

    • Emily, I’m so sorry to hear! That is such a bummer :( Keep me posted on how you progress.

    • Ashley Winget says:

      Just to give a little hope to those of you in despair about your IT band pain. I am Ashley from the above comment about my marathon being 3.5 weeks away…… So as an update, I had success from IT band rehab and was able to run my marathon without any IT band pain. It was tight, but not painful. But it killed for days after! Here is what I did. I Religiously foam rolled 3x a day about 3 minutes per leg. I rolled right down the middle for 1 minute, the other 2 minutes I slightly tilted forward for a minute and backward a minute, so that I got all angles of the band (hopefully that makes sense). I used ice cups on the insertion point at the knee, I did simple hip exercises to strengthen the hip as well (hip hikers, clams, standing hip flexion, extension, and abduction etc) I took a few days off running and biked at a fast speed in hopes of not losing too much training. Then the pain subsided in a few days, it wasn’t gone, but not too bad; I believe from the foam roller, but I’m no expert. I then started throwing running back into the mix along with biking. On my runs I slowed way down! I was able to get back into things pretty quickly with this probably 1.5 weeks. I attribute this to catching it VERY early. I knew what the pain was because my college teammate battled IT pain a lot when we ran together, so I knew what it was when it came on. I bought a foam roller and it saved me. I do know that my story is optimistically uncommon, but I just wanted to put it out there to give some hope. Also just a bit from my teammate who is an amazing runner, an exercise scientist and very knowledgeable about IT band pain as she had to research and learn from experience. She told me, “The IT band is unlike other injuries. Other injuries you rest and they go away. IT band pain will subside with rest but it will come right back when you start running again if you don’t rehab it.” you have to get your hips strong and break up the tissue on that dang band, or it will just pull at your knee. So my advice is foam roll and get your hips strong! Any way, hope that helps someone.

    • Ashley, thank you SO much for coming back and sharing this!! I’m sure it’s going to be prove very helpful for a lot of people.

      And while we’re sharing updates: I haven’t had IT issues for years, and I attribute that to the hip strengthening that Ashley mentions. It’s so easy to skip strength training when you’re running, but I’ve found that’s always led to injury for me.

  11. Thank you Laura for your replies!

  12. Steven Wood says:

    Just to let you know a happy outcome – after having to phone my wife to come and collect me in the car, 4 weeks later i managed to run the marathon (my first) on 4:11 – my knee was absolutely fine I am pleased to say. Well, my knees were sore, but nothing like the sharp pain on the outside of the knee that forced me to stop.

    I started to do some strengthening and stretching exercises and also did the plank and wall sit every night. Not sure if this really made any difference, but i guess i mustn’t have really injured it as much as aggravated it. I also loaded up on ibuprofen during the race :)

    • That’s fantastic news, Steven – huge congratulations! Sometimes some basic rest can do wonders – that’s been the approach I’ve been taking with a few injuries myself lately.

  13. I have not had serious IT band issues for years and it came suddenly- in 6 mile of my first marathon! So I run. At midpoint, it was worst, on cobblestones and tram tracks, but fortunately then I started to feel tired anyways, so I could ignore it more. I had to alter my pace and say farewell to my target time! So I ran slow, painful hell. People were running past me. A lot! Fortunately bananas at aid stations were seem to help and I was able to finish just 3 minutes under 4.
    So I couldn’t finish my A goal, but at least hit my goal B.

    • Way to push through it and finish anyway! I hope you’re recovering well now, and that foam rolling may help with recovery.

  14. I just wanted to post a quick update from first post back in August. About 6 weeks of physical therapy didn’t really help so I started looking into some alternatives. First, I started eating/drinking more turmeric which really helps with the healing process and inflammation. But what has truly been a Godsend is acupuncture. After the first treatment to my IT band, I felt better than I had in months. I kid you not, it’s like the pain wasn’t even there. I started doing 1-2 treatments per week and it’s helped me get through an accelerated version of the training, and I am running the Chicago marathon this weekend!!! Please consider looking into this if your having IT band issues (or any other running injury)- I really wish I would’ve looked into it sooner.

    • Emily, thanks so much for coming back to share this tip! I haven’t tried acupuncture myself but have heard great things about it from some friends. I’m particularly intrigued to see that it’s so effective in treating ITBS – hopefully this helps other runners heal.

  15. All these positive updates are really uplifting. I’ve dropped out of marathons before due to IT pain, but since September 2016 I’ve been training for one on March 12th that has a time limit of 7hours. If I get to the start line it will be my first marathon attempt. However, today my IT band flared up again, I tried to run/walk through it but it got beyond bearable. I stopped at 14km. With foam rolling and hip strengthening exercises do you think the marathon with still be doable? I think I also started off too fast today – my ego got the better of me until the 9th km. It is good to see people were able to run and with great times too- my target of five hours had currently been reduced to “just finish it before they kick you off the course”! any advice would be great, and happy new year!

    • Ellie, I’m so sorry to hear about your flare! What’s the longest distance you’ve completed in your latest training cycle? If you haven’t gone beyond 14K yet (and I know it’s probably early in the training cycle for you to have done much more), you’d definitely need some longer runs between now and your race, or consider switching to the half.

      March 12th is some time away, so it might be tough to sustain your current fitness if you aren’t able to run before the marathon – but I also think it’s far enough away that you could recover with some foam rolling/strengthening. Do you have access to an elliptical to do some training on in the meantime while you’re going through the recovery process?

    • Hi Laura! Thank you for your quick response! The 14km was supposed to be a half marathon but I just couldn’t go any further. However, I have been to have my running gait measured, some customised insoles made, and new sneakers (mine were god knows how many years old). I’ve also trawled the internet for all kinds of exercises to strengthen my glutes-they are weaker than I care to admit. My hips are also very tight so am doing a daily cocktail of strengthening and stretching, tennis ball massaging of the IT band etc. I don’t have access to an elliptical unfortunately but I will be changing my course to a flat course or soft grass. I will try some long runs again with a walk/run routine, but will leave it a week I think! On the day I’ll be carrying some ibuprofen and probably a hip flask! Feeling much better about it all and will add updates as I go xx.

    • All of that sounds like it should help!!! Definitely keep me updated… I’m crossing my fingers for you.

    • Hi Laura,
      Just an update on last month’s marathon-I did it! Yay! I mean, my knee started hurting at mile 2 and so by ‘did it’ I mean I pretty much wiggled my way around the last ten km, but I got done and within six hours.
      To prepare I did a lot of glute exercises and ham string stretches, as well as foam rolling after every run. I did two short runs a week followed by a long run-the longest of which was just over a half two weeks before the marathon.
      During the race my knee started to complain at mile two so I slowed my pace from 6:30 min/km to 7:30min/km and kissed goodbye to any time goal. From the half way mark I ran two km the walk/wobbled for half a km. this seemed to stave off pain until 35km where I ran a bit/walked a lot until the final few hundred meters.
      If I’m ever going to do one again I need to give myself at least a year of training and glute work. Still, it was doable and the feeling of finishing was amazing, in no small part to your article and everyone’s stories here xx

    • Ellie, I am so excited for you – CONGRATULATIONS!!! All the advice above is especially helpful for others in the same situation – thank you for coming back and sharing. How are you feeling now? Whether you do another marathon or not, I hope you’re feeling incredibly proud of your well-deserved accomplishment.

  16. Hi Laura!

    After reading this post and all these positive updates, I feel like I have hope again. I have given myself 3 weeks of rest due to knee pain from my IT band and ran my first half marathon of the year this past weekend. Once I hit mile 9, I really had to push through the pain. I was really hoping the rest and foam rolling I was doing would help get me through this race. If I was properly trained, this was a race I knew I could PR on. I have LA marathon on March 19, which is 5 weeks away and I’m worried I wont be able to get my long runs in. I’m going to try to stick with the 2 short runs a week with the long eliptical “run” on the weekends. Thanks for your help!

    • Becky, I’m so glad this post has been helpful to you! (And the community in the comments is AWESOME, too.) I’m so glad you were able to make it through the half marathon, and I wish you lots of luck in LA in a few weeks! Hopefully five weeks is long enough for you to heal and knock it out of the park :) Be sure to come back and let us all know how it goes!

  17. Hi Laura!

    Thank you so much for this article! My marathon is 6 weeks away. I’ve been following an 18 week training program but I got pretty sick 3 weeks ago (weeks 9/10) and had to take almost 2 weeks off with a few intermittent runs scattered. Yesterday I ran 8 and on the 6th mile or so I experienced the sharp pain that you described above and the last 2 miles home were a painful struggle. Today marks 12 weeks and is supposed to be my long run of 18. I’m nervous that I’ve already had to miss so much training already, and I’m too far out to simply rest and sustain my endurance (not to mention I was trying to qualify for Boston). Any advice? (Sorry this is lengthy!)

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