By Ryan Domeyer PT, DPT, CMPT
The iliotibial band (IT band) is a dense band of connective tissue that can contribute to pain in runners, cyclists, and athletes. Our IT band is not contractile tissue and therefore is not "tight." However, the IT band does serve as an attachment for the major muscles of you leg including your gluteal muscles, quadriceps, hamstrings, and hip flexors. IT Band Syndrome is a condition that can be caused by repetitive motion at the knee leading and most commonly leads to friction on the outside of the knee. Those with IT Band Syndrome will have complaints to ache or burning pain on the outside of the knee that worsens with prolonged activity. IT band syndrome can vary in presentation as can be a nagging ache after activity to totally limit ability to participate in repetitive activities. There are many factors that contribute to increased friction and most commonly is tightness on the front of the hip from sitting. Here are 3 ways in which you can prevent lateral knee pain: - Stretching:
-Stretching the muscles that attach to the IT band will help lessen the load placed on the outside of the knee
-Hold each stretch for 1 minute prior to activity and at least 2 min after activity
-Hold each stretch for 1 minute prior to activity and at least 2 min after activity
- Psoas (Hip Flexor)/Quadriceps
- Tensor Fascia Lata (TFL)
- Hamstrings
- Properly Foam Roll
The mechanism of why foam rolling is unknowns, however, a popular theory is that it works by causing a muscle to reflexively relax causes the muscle to relax and lengthen. The IT Band is thick dense tissue that unlike muscles is unable to be stretched and therefore does not benefit from direct compression with foam rolling. Despite popular opinions, foam rolling directly over the IT band does not release scar tissue or improve myofascial tension. There is no harm to using a foam roller to the IT band other than unnecessary discomfort. Instead, foam roll the muscles that attach the IT Band including the quadriceps, hamstrings, TFL, gluteus maximus/medius.
Dr. John Rusin does a great job describing the myths of foam rolling and how to properly foam roll around the IT band
- Prevent Knee Valgus
Knee valgus is movement of the knee inward which cause excessive stress and lead to multiple injuries including IT band syndrome. Proper alignment of the knee is a straight vertical line from hip, knee, and ankle. Valgus stress on the knee has numerous causes including:weak gluteal muscles, flatten arch, and walking/running like a duck with toes pointed out. Poor knee position is exacerbated during single leg landing especially during running. Work to improve position by: - Standing on 1 Leg- in a running position standing on 1 leg keeping your hips level, neutral arch position and preventing your knee from turning inward. Hold for 5-10 seconds focusing on proper knee position
- Supine Bridges- laying on your back with knees bent, lift your butt off the ground squeezing your gluteal muscles. Hold for 5 seconds and repeat 10 times.
If these self treatment techniques do not prevent or relieve the symptoms of IT band syndrome, you would benefit from a comprehensive movement examination from a physical therapist to provide the best way for you to get back to whatever activities you want to do.
References:
1. Falvey EC, Clark RA, Franklyn-Miller A, Bryant AL, Briggs C, McCrory PR. Iliotibial band syndrome: an examination of the evidence behind a number of treatment options. Scand J Med Sci Sports. 2010 Aug;20(4):580–7. PubMed #19706004.
