Suffering From
IT Band Syndrome?

IT band syndrome is a common knee injury, specifically in runners and cyclists. What exactly is the IT band? What are the symptoms of this condition? And most importantly, how can you minimize your knee joint pain?

What is the IT Band?

The IT Band, short for iliotibial band, is a strong fibrous structure located over the lateral or outside aspect of the thigh. The band stretches from the ilium of the pelvis and connects to the outside aspect of the tibia. It functions to help support the lateral thigh. However, tightness of the IT band can create painful conditions for both the hip and the knee.

IT band

What is IT Band Syndrome?

Classic irritation of the IT band occurs over the outside aspect of the knee. Tightness of the IT band can cause friction of the IT band at the point where it crosses the knee joint. This friction creates inflammation of the distal aspect of the IT band leading to pain.

Typical Signs and Symptoms

The most common symptom related to IT band syndrome is pain over the lateral aspect of the knee, specifically with repetitive knee bending and extending. Activities such as running, hiking, cycling, and stair climbing are the most common aggravators. Occasionally, in addition to pain, a feeling of clicking and snapping can also be felt over the outside aspect of the knee.

Pain from the IT band should not be confused with hip bursitis. Although tightness of the IT band can have an influence on hip bursitis, IT band syndrome causes pain at the level of the knee, not the hip.

In addition, symptoms that radiate down the lateral leg may not simply involve the IT band. Both nerve roots originating from the low back and superficial nerves that pass just below the knee joint can create symptoms that may be similar to those created by the IT band. If pain spreads or is non-specific, consider that something other than the IT band may be at work.

What Causes IT Band Syndrome?

The simple answer to what causes ITB syndrome is IT band tightness. Unfortunately this syndrome is more complicated than tightness alone. Biomechanics of the leg often play a big part in why the IT band becomes tight in the first place.

One of the common reasons why the IT band becomes tight is because of lateral hip weakness. The lateral hip has a number of different muscles that work to both move and stabilize the hip during activity. When the posterior (or back) muscle of the lateral hip becomes weak, the anterior (or front) muscle begins to work harder. Unfortunately this anterior muscle, called the tensor fascia latae (TFL), is attached to the IT band. Thus, when this muscle is working hard, it pulls up on the IT band creating tightness and increased tension on the band. This extra tension makes it easy for the IT band to rub against bony prominences as it passes the knee, leading to inflammation.

Another biomechanical component that can lead to IT band symptoms has to do with the foot. A foot that pronates allows the tibia to rotate inward (medially). Because the bottom of the IT band is connected to the tibia, this medial rotation winds up the distal IT band, allowing it to rub against the outside of the knee.

knee valgus

Another cause of IT band syndrome is specific to cyclists. Because cycling is a non weight bearing activity, the issues of foot biomechanics and lateral hip strength do not have the same impact. Rather, IT band pain is most often related to equipment fit and function. A bicycle seat that is not in the correct position can impact the position of the IT band as it crosses the knee. And, the position of the toe clips can have a similar effect on tibia rotation, adding to increased IT band tension.

IT Band Treatment

The first step in treating an inflamed IT band is to reduce the inflammation. The easiest way to reduce inflammation is to utilize ice therapy. Apply ice for 10 minutes at a time a few times a day. Ice massage also works well with the distal IT band. To use ice massage, fill Styrofoam cups with water and freeze them. Peel off the top of the cup and massage the exposed ice over the lateral knee for 5 minutes.

Anti-inflammatory medication is frequently recommend for reducing inflammation (consult your doctor regarding medications). In addition to oral anti-inflammatories, topical medication such as Voltaren gel can also be effective.

The next logical step to address a tight IT band is to improve its flexibility. One of the more effective ways of decreasing IT band tightness is utilizing a foam roll. These rolls can often be purchased at sporting goods stores. To use the roll, lie on the roll with the involved side down. Use your upper body to control your leg as you roll your lateral thigh over the foam roll for 30 seconds and repeat a few times a day. As a warning, this exercise is rather uncomfortable at first but does improve over time.

IT band foam roll

Because the IT band is fascia and not a muscle, stretching the IT band does not feel the same as stretching a muscle. To stretch the IT band, stand against a wall with the involved leg next to the wall. Cross the uninvolved leg in front. Shift the hip of the involved leg towards the wall and hold for 30 seconds.

standing it band stretch

Performing a simple hip exercise will address common lateral hip weakness issues. It is very important that you utilize correct form when doing lateral leg lifts. Do not allow the leg to move forward when performing the leg lifts. Perform 3 sets of 10 every day. Be aware that strength improves slowly so be consistent and symptoms will improve over time.

sidelying  hip abduction

Finally, if your foot tends to pronate, getting a pair of supportive shoes and possibly shoe inserts will help to address this biomechanical issue. Even if you are not a runner, using a good pair of stability or motion control running shoes can be very effective in controlling this extra foot motion.

Physical Therapy

If home treatment is not effective in reducing your IT band pain, consider seeking help from a physical therapist. The use of modalities such as ultrasound, phonophoresis, and iontophoresis can be helpful in reducing local tissue inflammation. Manual soft tissue massage of the IT band can also be helpful in reducing tissue tightness.

IT band syndrome can become chronic and annoying. Address all potential causes and be consistent with implementing treatment recommendations and soon you’ll be back on your feet.

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