Running Series: IT Band-Related Pain

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What Is It?

If you complete a simple Google search, you’ll find all kinds of websites saying that IT Band Syndrome is caused by tightness of your IT Band, which then causes a friction over the area of the knee when you flex and extend. If you view the picture below, you can see that the IT band runs from your hips to just below your knee. 

Physical-therapy-IT-band-pain

By just glancing at the picture, and listening to Dr. Google, maybe it’s understandable why the word “friction” is thrown around all over the place. However, it’s important to keep up-to-date and continue to learn. This “friction” theory has been debunked and we hope to shed some light on a few myths surrounding this all-too-common injury.  

Let’s dive right in…

Myth #1: IT Band Syndrome is a friction syndrome, meaning your pain develops from too much friction between structures.

Fact #1: IT Band related pain is much more likely due to impaired hip function, rather than a friction syndrome

At MVMT Performance & Rehabilitation, almost everyone we see is educated on proper hip mobility, stability, and strengthening. The reason we place so much focus on the hips is because they are the central region of the body and play a role in almost all functional movements. If you are lacking proper hip mobility, strength, and/or mechanics, we can almost guarantee that you will be dealing with some pain and/or injury either in your upper or lower body.  

All of the muscles that run into or under the IT Band connect to the hip. Intrinsic risk factors, such as weak gluteus muscles and decreased hip internal rotation, place added force on the knees and don’t allow for proper control and stability of the core muscles (i.e. glutes). 

A study by Noehren et al. looked at these factors. They viewed the biomechanics of runners with IT Band syndrome and individuals without. In the group dealing with IT Band Syndrome, they found that the group with ITBFS had great hip adduction and knee internal rotation (I.e. knee valgus). This suggests that the rehab should focus on controlling these movements through strengthening, stretching, and neuromuscular re-education. 

A second study by Fairclough et al., furthers this point, “Our view is that ITB syndrome is related to impaired function of the hip musculature and that its resolution can only be properly achieved when the biomechanics of hip muscle function are properly addressed.” 

Myth #2: "My IT Band is 'tight' and to get it better, all I have to do is stretch and foam roll."

Fact #2: You can't change the extensibility of the IT Band.

One of the most common things we are asked is, “how can I stretch my IT Band?” Well, you can’t, and let us explain why. 

The IT Band is a band of connective tissue known as fascia. Fascia has a different makeup than muscles, tendons, and ligaments. One of the key differences here is that muscle is contractile tissue, meaning that it can stretch (think of a rubber band) and tighten. The IT Band, being fascia, is not a contractile tissue, and therefore cannot get “tight.”  

The IT Band lies on top of muscle, so you can absolutely spend time stretching and foam rolling the tissues that lie underneath and insert into the IT Band. At the hip, two muscles that insert into the IT Band are the tensor fascia latae (TFL) and the gluteus maximus. The thick piece of fascia then runs down the lateral (outside) portion of your leg and lies on top of the vastus lateralis (outer-most quadriceps muscle) and the biceps femoris (outer-most hamstrings muscle). If you want to focus on stretching, foam rolling, smashing with a lacrosse ball – these are the areas that would be much more worth your time. 

Myth #3: IT Band Syndrome only occurs in runners.

Fact #3: IT Band Syndrome is common amongst cyclists and sedentary individuals, along with runners.

IT Band syndrome is prominent amongst runners (~5-14% of runners deal with this), but they are not the only athletes or individuals we see in the clinic that present with similar lateral knee pain. There is also incidence of these symptoms in cyclists. Now, we know what you are thinking, both these athletes are continuously bending and straightening their knee causing excess friction to the band attachment site at the knee. But, recall myth #1 – this is not a friction syndrome! It’s more likely these athletes develop lateral knee pain for two reasons: (1) impaired mobility or control at the hip OR, (2) a rapid increase in training. 

This leads us to another population that may develop IT Band related symptoms. Individuals with a low threshold for physical activity (such as sedentary lifestyles or recent post-surgical patients) who become active and progress loading too quickly.  So yes, like many other running related injuries that we have discussed in this series (plantar fasciitis, shin splints, etc.), IT Band syndrome is likely from overuse.  

What Can You Do About IT Band Issues?

Soft Tissue Mobilization

  • Trigger points or “knots” can cause referred pain to the knee
  • The muscles you are targeting are the Vastus Lateralis, TFL, Gluteus Medius/Minimus
  • Hang out on the hotspot for 1-2 minutes

Pretzel Stretch

  • This is a great stretch to increase hip joint mobility and decrease muscle tension through the front and outer thigh
  • Contract-relax method of stretching works very well with this stretch
  • Follow the video for proper explanation on how to complete this stretch

Standing Fire Hydrants

  • SL RDL focuses on lower extremity stability, balance, and motor control
  • It builds strength of the posterior chain
  • And emphasizes a functional movement pattern – the hip hinge!

References:

Noehren B, Davis I, Hamill J. ASB Clinical Biomechanics Award Winner 2006. Clinical Biomechanics. 2007;22(9):951-956. doi:10.1016/j.clinbiomech.2007.07.001. 

Fairclough J, Hayashi K, Toumi H, et al. Is iliotibial band syndrome really a friction syndrome? J Sci Med Sport. 2007;10(2):74-76. doi:10.1016/j.jsams.2006.05.017

Looking For More Help?

*This is helpful information, but it is general information. This is NOT medical advice. If you already have any injury, pain, tightness, etc., please seek help from a licensed and qualified healthcare provider like us, performance physical therapy in Green Bay. A complete solution for what you’re dealing with needs to be customized to all the different factors driving your pain, and those factors will be at least slightly different for each person. These strategies may help, but they’re not likely to be a complete solution for each individual reading this now or in the future.