| IT Band Syndrome |
There have been so many questions lately about recurrent IT Band
Syndromes (ITBS) that I thought I should get a comprehensive
treatment page up that everyone can refer to. That way future
inquiries can just be referred here rather than everyone
regurgitating what was said before.
First, how do you know you have ITBS? Common symptoms are:
Exquisite pain on the outside of the knee, often with a feeling that the
knee will buckle. The pain can radiate above and below the knee on
the outside. It is most common in runners and occurs most
frequently while running downhill or on crowned roads. The pain
usually begins after the same amount of time into a run each time
and often running for this amount of time is the only way to
reproduce the symptoms. You may be able to cycle, lift weights or
perform aerobic machines without any pain. Pressing at the site of
pain (at rest) often does not elicit any tenderness.
Slightly less common is pain at the hip itself. It is usually nagging or
burning in nature and is often less intense than the knee pain. It
can be painful to lay on that side in bed and pressing on it often
brings symptoms.
What is the IT Band is. The IT Band is a tendonous tissue that
begins at the upper portion of the pelvis as the tendon of the Tensor
Fascia Latae muscle. It also has originating fibers that attach to our
gluteal muscles. It is a flat thin structure that runs down the outside
of the leg providing lateral stability to the knee and hip and acting as
a counter-pressure barrier for the vastus lateralis quadricep muscle.
It attaches to the outside of the knee in a number of places, including
the lateral tibia and the extensor retinacula of the knee.
Why does ITBS occur?
This question could require many hours of explanation from a
physical therapist and still not exhaust all the causes. The most
common areas of pain are right over the point of the hip and on the
outside of the knee (which can extend from a few inches above the
knee to referred discomfort on the outside of the upper calf!)
Commonly the IT Band is rubbed over the bones it lies on top of which
causes irritation. The lower portion is thought to "snap" over the
lateral epicondyle of the femur, while the upper portion can be rubbed
over the greater trochanter of the femur. There is rarely an audible
"snap" that occurs, but merely the friction compunds over time and
over use to cause what amounts to an internal friction burn (like an
Indian burn).
What causes this rubbing?
The IT Band is pulled tight over these bones due to poor alignment of
the joints above or below the problem area. It can be caused by
something as simple as a runner whose right hip juts out slightly to
the side when they land on that foot. This hip jutting out causes the
ITB to be stretched slightly.
The two most common dysfunctions that cause this are poor foot
mechanics and weak lateral hip muscles.
Most runners foot mechanics are fine, but we tend to run a lot on
cambered roads which makes one foot conform to the ground in a
dramatically different way. Staying off cambered roads (hit the trails!)
can help some people beat their ITBS. If your foot mechanics are truly
the problem then orthotics may be in your future. First, though, you
may try some calf and intrinsic foot muscle strengthening exercises
(see sidebar to the right) along with some running shoes with a bit
more stability built into them. These two ideas are a much cheaper
first step.
In my experience as a physical therapist I believe that weak hip
muscles are the most common culprit of ITBS. In the article linked
to below they provide excellent stretching and strengthening
exercises to speed you along to recovery. The entire article is a great
resource for the how and why. It is a little technical, but thorough.
The stretching exercises are listed first after the section titled
"Treatment and Rehabilitation"
ITBS article
Syndromes (ITBS) that I thought I should get a comprehensive
treatment page up that everyone can refer to. That way future
inquiries can just be referred here rather than everyone
regurgitating what was said before.
First, how do you know you have ITBS? Common symptoms are:
Exquisite pain on the outside of the knee, often with a feeling that the
knee will buckle. The pain can radiate above and below the knee on
the outside. It is most common in runners and occurs most
frequently while running downhill or on crowned roads. The pain
usually begins after the same amount of time into a run each time
and often running for this amount of time is the only way to
reproduce the symptoms. You may be able to cycle, lift weights or
perform aerobic machines without any pain. Pressing at the site of
pain (at rest) often does not elicit any tenderness.
Slightly less common is pain at the hip itself. It is usually nagging or
burning in nature and is often less intense than the knee pain. It
can be painful to lay on that side in bed and pressing on it often
brings symptoms.
What is the IT Band is. The IT Band is a tendonous tissue that
begins at the upper portion of the pelvis as the tendon of the Tensor
Fascia Latae muscle. It also has originating fibers that attach to our
gluteal muscles. It is a flat thin structure that runs down the outside
of the leg providing lateral stability to the knee and hip and acting as
a counter-pressure barrier for the vastus lateralis quadricep muscle.
It attaches to the outside of the knee in a number of places, including
the lateral tibia and the extensor retinacula of the knee.
Why does ITBS occur?
This question could require many hours of explanation from a
physical therapist and still not exhaust all the causes. The most
common areas of pain are right over the point of the hip and on the
outside of the knee (which can extend from a few inches above the
knee to referred discomfort on the outside of the upper calf!)
Commonly the IT Band is rubbed over the bones it lies on top of which
causes irritation. The lower portion is thought to "snap" over the
lateral epicondyle of the femur, while the upper portion can be rubbed
over the greater trochanter of the femur. There is rarely an audible
"snap" that occurs, but merely the friction compunds over time and
over use to cause what amounts to an internal friction burn (like an
Indian burn).
What causes this rubbing?
The IT Band is pulled tight over these bones due to poor alignment of
the joints above or below the problem area. It can be caused by
something as simple as a runner whose right hip juts out slightly to
the side when they land on that foot. This hip jutting out causes the
ITB to be stretched slightly.
The two most common dysfunctions that cause this are poor foot
mechanics and weak lateral hip muscles.
Most runners foot mechanics are fine, but we tend to run a lot on
cambered roads which makes one foot conform to the ground in a
dramatically different way. Staying off cambered roads (hit the trails!)
can help some people beat their ITBS. If your foot mechanics are truly
the problem then orthotics may be in your future. First, though, you
may try some calf and intrinsic foot muscle strengthening exercises
(see sidebar to the right) along with some running shoes with a bit
more stability built into them. These two ideas are a much cheaper
first step.
In my experience as a physical therapist I believe that weak hip
muscles are the most common culprit of ITBS. In the article linked
to below they provide excellent stretching and strengthening
exercises to speed you along to recovery. The entire article is a great
resource for the how and why. It is a little technical, but thorough.
The stretching exercises are listed first after the section titled
"Treatment and Rehabilitation"
ITBS article
| Sidebar Towel scrunch: lay a towel flat out on the groung. Place your foot on top of it and use your toes to scrunch it up into a wrinkled mess. Toe raises: this is the old calf strengthening stand by, but with a little twist. Try to raise up as high as you can on your toes to the point where you are no longer just using your calf muscles, but also the muscles in your foot to reach that extra height. Then lower down as slow as you can manage to go. |
Adhesions
Some people may develop adhesions of the IT Band.
Normally the IT Band enjoys a bit of freedom of movement
from the surrounding tissues. It is able to slide slightly over
the structures below. Think of adhesions as little spots
where the IT band is stuck to the tissue below it. When this
happens it causes improper pulling and increased tightness
of the IT band along with pain. These adhesed spots pull not
only on the IT band but also on the tissue below and
therefore cause increased discomfort especially in the thigh
(or the muscular) portion of the IT band.
Stretching has not been shown to be a good way to break
these adhesions, primarily because the amount of movement
you can get out of the IT band is very limited and often does
not generate enough force to pull these adhesions apart.
Deep tissue release is a good way to break up these
adhesions. The picture in the ITBS article showing the man
rolling the outside of his leg over a foam roll is a great way to
release these tissues. Another way is to use a golf ball (or a
tennis ball if it is too sensitive) to press into the tissue off the
lateral thigh. Basically you would be rubbing the golf ball
deeply into the IT band as if you were kneading out some
very tough dough. Work in the direction that the IT band
runs (up and down) and perpendicular to it as well (side to
side). See the picture at the right.
Some people may develop adhesions of the IT Band.
Normally the IT Band enjoys a bit of freedom of movement
from the surrounding tissues. It is able to slide slightly over
the structures below. Think of adhesions as little spots
where the IT band is stuck to the tissue below it. When this
happens it causes improper pulling and increased tightness
of the IT band along with pain. These adhesed spots pull not
only on the IT band but also on the tissue below and
therefore cause increased discomfort especially in the thigh
(or the muscular) portion of the IT band.
Stretching has not been shown to be a good way to break
these adhesions, primarily because the amount of movement
you can get out of the IT band is very limited and often does
not generate enough force to pull these adhesions apart.
Deep tissue release is a good way to break up these
adhesions. The picture in the ITBS article showing the man
rolling the outside of his leg over a foam roll is a great way to
release these tissues. Another way is to use a golf ball (or a
tennis ball if it is too sensitive) to press into the tissue off the
lateral thigh. Basically you would be rubbing the golf ball
deeply into the IT band as if you were kneading out some
very tough dough. Work in the direction that the IT band
runs (up and down) and perpendicular to it as well (side to
side). See the picture at the right.
All of the above information is non-invasive and realtively safe (take that as the disclaimer
for this entire page....if you do too much of anything it can be harmful, so be careful and
seek professional help if you need to). There are other treatments available like
iontophoresis, cortisone injections and even surgery, but they require the intervention of a
health professional and cost a lot more money. If you have no luck with what I have written
here so far then it may be time to consult a physical therapist or a sports med physician for
further treatment.
If I get enough interest (this is all I could get on here in the hour I had
available--I will be adding a section on the use of ice and heat) I will continue to
expand this page to be more and more comprehensive (with exercise
progressions, etc.) so let me know if you have questions.
Good Luck
John
for this entire page....if you do too much of anything it can be harmful, so be careful and
seek professional help if you need to). There are other treatments available like
iontophoresis, cortisone injections and even surgery, but they require the intervention of a
health professional and cost a lot more money. If you have no luck with what I have written
here so far then it may be time to consult a physical therapist or a sports med physician for
further treatment.
If I get enough interest (this is all I could get on here in the hour I had
available--I will be adding a section on the use of ice and heat) I will continue to
expand this page to be more and more comprehensive (with exercise
progressions, etc.) so let me know if you have questions.
Good Luck
John
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