Iliotibial Band Syndrome: Why It Happens, and How You Can Help It

27 Mar

knee_pain-225x300

If you don’t know what your iliotibial band is, try rolling the side of your leg with a PVC pipe. You’ll find out real quick.

Out of all the complaints you will hear most often in any sort of athletic activity, “I have pain in my knee(s)” is the most prevalent. This usually ranges anywhere from a very sharp and stabbing pain, to a dull ache, to just plain old discomfort.

Now, it’s easy to just look for the simplest reasoning possible and pin your pain on that – but it’s not always the most accurate. In order to find out what is actually going on, understanding the various different muscles, tendons, and ligaments in the leg – or any body part/area –  is important for pin-pointing what caused the pain and where the pain is actually coming from.

Just as with runners and cyclists, superficial knee pain is extremely common among weightlifters as well. And it is usually do to an imbalance rather than simply performing a movement in the wrong fashion and ending up with knee pain. But let me break down for you first what goes on in your leg every time you bend your knee.

What is the IT band?

The IT band is a strip of fascia that stretches from the top of the hip down to the knee, and inserts into an area outside of the knee just below the knee joint known as the lateral tibial tubercle (LTT; or, “Gerdy’s tubercle”). The IT band basically acts as a force transmitter from the hip down to the knee.

When you are bending and extending your knee, the IT band’s position changes. When your leg is bent at a 30 degree angle, it goes into what is called the “impingement zone”, and that’s where most of the friction happens. If there is too much friction going on it causes inflammation. This in turn can lead to scar tissue being formed, and/or tissue degeneration. As an example, in the case of a cyclist or runner, repetitive motion causes a lot of friction in this area, which is why so many distance runners experience ITBS, also occasionally referred to as “runner’s knee”. In essence, ITBS is an overuse injury. 

So while most people would think the solution to be rest, massage, stretching, etc., this seems to only delay symptoms, but not actually target the real problem. In addition to these things, rehabilitation exercises must also  be performed to strengthen the supporting muscles.

When an area on your body is weak, the nearest muscles will attempt to jump in and perform the movement in place of the weaker one(s). For example, if you have very weak hamstrings and stronger quads, when performing a squat the tendency will be to shift forward onto the toes, which would place the emphasis on the front half of your body rather than your posterior chain. The body knows nothing about form or technique – it only cares about getting the weight up no matter what. So where one area is weak, another area will try to act in its place.

Now, there is a little-known hip abductor muscle known as the tensor fasciae latae (TFL) which aids in pelvic stability and the bracing of your knee, for example when the opposite foot is lifted. This muscle will also attempt to compensate for a weakened gluteus medius and minimus, should the situation arise. The TFL is actually directly connected to the IT band. As a result, if there is direct stress being placed on the TFL, the stress will transfer to the IT band, which will then transfer the pain to your knee.

Anterior_Hip_Muscles_2 (1)

See where this is going?

Essentially, strengthening the glutes and hips, as well as freeing up your tight IT band will result in less pain (provided the injury is superficial).

Regardless if you are uncertain as to what is causing the knee pain, strengthening the glutes and hips will always be beneficial, and 9 times out of 10 will also be the solution to your discomfort during training (running, cycling, squatting, etc.) or at rest.

This is why it is very important to understand every area of your body and the way it operates so that you can look not only for temporary solutions, but long-term solutions. Rehabilitation through proper assessment of weak-points and targeted exercises is the best way to help prevent injuries from recurring. This could take anywhere from a week to several weeks, but as long as you are committed, the relief will come.

So – what are some steps you can take towards strengthening the glutes and hips?

The first step, obviously, is to stop doing what is causing you pain. If you are having a lot of pain in your knees while squatting, I recommend you stop squatting. This doesn’t mean forever, it means temporarily – at least until you have strengthened the weak areas a little. Perform movements that do not cause pain to prevent further inflammation.

Next steps:

  • Mobility work. This needs to be performed before every lower body training session, and for 5-10 minutes or so every morning.
  • Rehabilitation exercises focusing on the lateral hip, pelvic stabilization, and glutes.
  • Foam rolling the IT band at least 2-3x per week.

Recommended mobility routine to follow (lateral hip/glutes):

  • Lateral Leg Raises
  • Clam Shells
  • Pelvic Drops
  • Hip Thrusts With One Leg Elevated
  • X-Band Walks
  • Iron Cross

If you are experiencing pain currently, or it is on and off, you can do this routine every day if you’d like. I’d recommend 25-40 reps per movement, 1-3 sets. If you have experienced pain before and don’t currently have it, I would still recommend doing this for general prevention, glute activation, and stability.

In addition, hip flexor mobility should be performed on a daily basis, regardless of pain being present or not.

Recommended hip flexor mobility exercises:

  • Cossacks
  • Pigeon
  • Fire Hydrants
  • Hip Swings
  • Walking Lunges
  • Glute Stretch With One Leg Out-Stretched
  • Frog Walks

 

Other exercises:

  • Cable Hip Abductions
  • Pistol Squats
  • Glute bridges
  • Split Squats (Bulgarian or regular)

Of course, you will want to make sure to be stretching the glutes as well. Roll these along with your IT band to help break down and prevent new scar tissue from forming.

source: drillsandskills.com

source: drillsandskills.com

glute-stretches1SeatedGlute

In general, so long as exercises (mobility and rehab) are performed consistently, you should see significant progress within the first 2 weeks.

Happy training!!

References:

Clinical Journal of Sport Medicine, 10:169–175 Linderburg G, Pinshaw R, Noakes TD. Iliotibial band syndrome in runners. Phys Sportsmed 1984;12:118–130

R Khaund, M.D. and S Flynn, M.D., Iliotibial Band Syndrome: A Common Source of Knee Pain, the American Academy of Family Physicians, April 15, 2005.

Beers, A., Ryan, M., Kasubuchi, Z., Faser, S., Tauton, J.E., 2008. Effects of multimodal physiotherapy, including hip abductor strengthening, in patients with iliotibial band friction syndrome. Physiotherapy Can. 60:180-188.)

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Questions? Observations? Leave me a comment below.

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3 Responses to “Iliotibial Band Syndrome: Why It Happens, and How You Can Help It”

  1. Shellie March 28, 2013 at 3:30 pm #

    The IT band a bitch and when I tore mine (rugby, not lifting) it was brutal and took 8-10 months to heal. This managed to come at a perfect time because as of yesterday (even though I’ve been pain free for about 5 months) I’m getting the lovely sharp stabbing pain of my old injury.

    My PT also had me do this stretch which feels pretty great if you get it just right: [url]http://namaste-massage.net/wp-content/uploads/2011/09/it-band-stretch1.jpg[/url]

    and he also iced used this for about half an hour: [url]https://www.thestick.com/cgi-bin/commerce.cgi?preadd=action&key=SG-1900[/url]

    ^that is so much more painful than a roller, but you have to have someone else do it for you…you’ll also want to ice after, sometimes it leaves a bruise.

  2. Missy B March 29, 2013 at 4:16 am #

    I love you for writing this post. I have a vendetta with squats because of my IT band and have ceased doing them the past few weeks to work on flexibility… while I love doing them, I don’t have perfect form. Hoping between what you suggest and mobilityWOD I can re-assess in 6-8 weeks.

  3. Paige Westbrook March 31, 2014 at 2:38 pm #

    My doctor recommended a golf ball muscle roller for my ITBS, surprisingly worked very well, check it out!! http://zzathletics.com/Golf-Ball-Muscle-Roller-Massager-GBMR1.htm

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