Symptoms Of It Band Syndrome
The main symptoms of Iliotibial Band Syndrome are:
- Lateral Knee Pain: pain over the outer side of the knee, especially when the heel strikes the floor. The pain is worse with running and stairs, especially when going down. It may also hurt to bend and straighten the knee.
- Knee Swelling: on the outer knee due to inflammation or thickening of the Iliotibial band.
- Popping/Snapping Sensation: this can occur when you bend the knee as the IT Band flicks over the lateral epicondyle.
Piriformis Supine Figure 4 Stretch
The small, band-like piriformis muscle helps with stabilizing the sacroiliac joint , externally rotating the leg, and abducting your leg when your hip is flexed. Addressing the tightness of the piriformis through stretches can help alleviate IT band-related knee pain. When it comes to stretching routines, the piriformis tends to get overlooked because its so small.
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I appreciate what appears to be a well-researched, sobering, humble but hopeful approach to this complex condition.~ Frankie Koch
I really appreciate your objectivity.~ Dr. Bryan Allf, MD, North Carolina
Very much improved since reading your tips and admonitions …~ Leanne Schultz, runner, Victoria, Canada
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Classifications Of It Band Syndrome
Iliotibial band syndrome can be classified as either mild, moderate, or severe depending on the intensity and duration of the symptoms. The pain is usually localized over the lateral condyle of the femur just above the lateral joint line of the knee. The pain may also radiate either up the IT band to the hip or down the IT band to its insertion on the tibia.
Athletes who experience pain towards the end of their activity and in which they are still able to continue would be classified as having a mild iliotibial band syndrome. The pain may be more noticeable during the phase of heal strike through mid-stance when the IT band is in its tightest position between the greater trochanter of the femur and the lateral femoral epicondyle.
As the condition worsens, the athlete may feel pain earlier and earlier during his/her activity. The pain will eventually affect the athletes ability to continue. The athlete may also begin to feel pain during weight-bearing activities such as walking down a flight of stairs. This would be classified as a moderate iliotibial band syndrome.
The condition is classified as severe when the pain restricts all running and becomes constant throughout all activities during the day.
Be More Conscious Of Your Knee Position
If you were throwing a ball back and forth with a friend and your elbow started to hurt with each throw, what would you do?
Would you kind of ignore it and keep throwing the same way as before?
Would you try to change the way you’re throwing, even though that way of throwing had never bothered you before?
The same goes with running, cycling, squatting, lunging, snatching…but it’s kind of controversial isn’t it? On one hand, you don’t want to alter the way you’ve done something for years and potentially screw up your form. On the other hand, if your form continues to be linked somehow to pain, then isn’t it a little crazy to stick with something that’s not helping?
One specific thing about “form” that I see pretty consistently is that many athletes with ITB problems struggle to control their knees against valgus or femoral adduction and internal rotation moments.
The stress on your knee in this position is less than great…and while every once in awhile it’s no big deal , it’s a not a position we want to promote – especially in a loaded, repetitive manner.
So with that in mind, here are a few drills I have my patients work through to make sure they’re a bit more aware of their knee position, and to try to get better at controlling it.
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Stop Wasting Your Time Stretching Things That Don’t Actually Stretch
It takes over 2000 pounds of pressure to cause the IT Band to “stretch” or change just 1%. So unless you’re hiring a farmer to hoist a bull onto your outer leg OR youre going to have a small car run you over, you’re probably not actually stretching your IT Band as much as you think you are with some of the stretches that are out there on the internet.
If you’re going to foam roll or stretch, I’d recommend instead focusing on the more malleable areas of the hip that attach to the IT Band such as the gluteal muscle groups and the TFL .
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Simple Home Exercises And Stretches Can Help Ease Some Common Types Of Knee Pain
If youve got sore knees, exercise might seem like the hardest thing you can do but its also one of the best.
“Exercise is one of the most important things you can do for knee pain,” says Dr. Lauren Elson, an instructor in physical medicine and rehabilitation at Harvard Medical School.
The right combination of strengthening and stretching exercises can relieve pain by helping to improve the way the joint moves and functions.
“The knee is often an innocent bystander between the hip and the foot. Knee pain is often caused by problems occurring above or below,” says Dr. Elson.
For example, weak hip muscles may cause more strain on the knee, intensifying your pain. Strengthening the muscles around the hip joint can help relieve it, says Dr. Elson.
In addition, knee pain is sometimes caused or aggravated by tight muscles around the knee, a problem that is often successfully addressed by stretching. If the muscles arent flexible, the knee joint sometimes wont move properly, says Dr. Elson.
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Exercise 3 Clam Shells With Miniband
Starting position: Lie on your side. Position a miniband between your knee and thigh and bend your knees slightly.
How to perform the exercise: Stabilize your body with your right arm on the floor and then open your knees like a clam. Pull the band apart slowly but firmly and try to engage your hips and core muscles. Let the band pull your legs back together and then repeat the movement again.
Duration: 3 x 10 repetitions per side
As soon as you are pain free for about 10 days, you can try an easy test run. You should keep it short and make sure to warm up well. You can find useful tips and stretches for warming up in this blog post. Its best if you run your test run on a treadmill or do a short, flat loop. This way you can stop at any time if the pain should return again. If everything goes well, you can slowly increase the distance per day. Here you can find some more tips on how to bounce back from a break in your training.
Stretching Or Foam Rolling The It Band Is Not The Solution
Again, the IT band itself is not a muscle that can be stretched or released. It is a piece of connective tissue with the purpose of holding things tightly together. While it might feel painful and give you the illusion that it hurts so good when pressing directly on the IT band, it is not doing you any good.
Any relief that you get will be temporary, and the pain and tightness on the outside of the knee will soon return because the tightness and/or weakness in the TFL, gluteus medius, and gluteus maximus has not been addressed. Instead, you should focus on the muscles in the surrounding area.
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Iliotibial Band Syndrome Anatomy
For those who arent familiar with Iliotibial Band Syndrome, lets start by having a look at the muscle responsible for the problem.
The iliotibial band is a thick tendon-like portion of another muscle called the tensor fasciae latae. This band passes down the outside of the thigh and inserts just below the knee.
The diagram to the right shows the anterior view of the thigh. If you look towards the top left of the diagram, youll see the tensor fasciae latae muscle. Follow the tendon of this muscle down and youll see that it runs all the way to the knee. This thick band of tendon is the iliotibial band .
The main problem occurs when the tensor fasciae latae muscle and iliotibial band become tight. This causes the tendon to pull the knee joint out of alignment and rub against the outside of the knee, which results in inflammation and pain.
Forward Fold With Crossed Legs
Start in a standing position with your feet together. Cross your right leg over your left leg, setting your right foot down to the outside of your left foot. Reach down toward your left foot and breathe deeply. Hold for 30 seconds as the muscle releases.
Do the same with the opposite foot. Repeat five times.
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What Conditions Can Exercise Help
Knee exercises and stretches can help relieve knee pain caused by many conditions, including these three that commonly affect older women:
Patellofemoral pain. This condition typically causes a dull, aching pain in the front of the knee thats made worse by daily activities, such as squatting, going up or down stairs, or standing up after sitting for a long period of time. The pain is caused by irritation of the cartilage underneath the kneecap when it does not glide or sit properly. Exercise can help to eliminate problems that lead to this irritation. Stretches can loosen tight muscles on the side of the knee that may be pulling the kneecap out of its groove as it moves. Strengthening weak hip muscles or stretching tight muscles in the front or back of the legs can also reduce discomfort.
Chronic degenerative meniscal tears. When one or both pads of cartilage that cushion each of your knee joints deteriorates or tears, you may feel pain and a sticking or locking sensation. While surgery is sometimes necessary, doctors usually first recommend physical therapy to help build up the muscles around the knee to take the pressure off the joint and reduce discomfort.
Understanding It Band And Knee Pain
Theres a lot of misinformation out there about how to stretch the iliotibial band, a thick band of connective tissue that runs along the outside of your thigh from your hip, past your knee, and to the top of your shinbone, or tibia.
The first thing to know about the IT band is that its not a muscle its a layered band of fascia, which is a type of connective tissue that surrounds and supports a variety of tissues, including organs and muscles. Its properties are different from those of muscles: stronger, less pliable, and less responsive to the act of stretching.
Its inflexibility may sound like a bad thing, especially if youre experiencing IT band-related pain and tightness, but its design furthers its purposeto help stabilize the knee. You dont want a super-flexible IT band because that would cause the knee to become less stable and, therefore, more prone to injury and pain.
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What Causes It Band Syndrome
An anatomy and physiology lesson seems in order to better understand IT band syndrome.
As you bend and extend your leg, the IT band glides over your upper thigh bone and top of the tibia . Repeating the motion over and over again slowly works to tighten your IT band, explains Krampf.
As the tissue grows more taught, friction develops as it begins to rub over your bony infrastructure. That rubbing leads to irritation and inflammation that can reveal itself as an intense and persistent pain in your knee or hip.
Many include IT band syndrome as a cause of runners knee given how often it slows those who pound out miles. Its also common among cyclists and weight lifters .
Its not just athletes seeking answers for IT band syndrome, though: The injury also has been connected to wearing high heels and even sitting at a desk with your knees bent for hours at a time.
Maintain Strength And Flexibility
Maintaining overall strength and flexibility in the body can help to prevent a variety of injuries and physical ailments. To read more about recovering from overuse injuries check out this blog. Focusing in particular on the lower back, hips, knees and leg muscles can help to protect the body and prevent IT band syndrome from cropping up.
Research has found that weak gluteal muscles can be one of the major contributors in the development of IT band syndrome.3 This is particularly true of runners where weak hip muscles can interfere with your correct running form meaning that the workload your hips should be bearing is then piled onto the knees instead. Running downhill is also thought to be a factor as we have less control and a decreased ability to stabilise the pelvis. To find out how you can improve your running form check out our tips on how to improve your running technique.
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Standing It Band Stretch
Since the IT band attaches to the pelvis through the tensor fascia latae and gluteal muscles it is important to stretch these muscles as well. The standing IT band stretch pictured above was found to be the most effective as Fredericson and colleagues showed and average length increase of 11%.
To perform this exercise:
All the above displayed exercises are easy to execute and include minimal risks if performed as described. To achieve satisfying results, it is important do them on a regular basis and for a minimum of 4 weeks. The general guideline for progressing, called the 10% rule, where total training , is not increased more than 10% per week.
Although there are many approaches to hip strengthening hopefully this has provided insight into some basic strengthening strategies. Should your clients condition worsen at any time, an evaluation with a medical professional would be warranted.
See more IT Band Stretches by following the link to an additional blog post.
Corrective Exercises To Treat It Band Syndrome
Although there is some debate in the literature in regards to the exact mechanism of IT band syndrome as to whether it is caused by weakness of the gluteal muscles or due to overuse and subsequent pain causing motor control changes, the one thing that is clear is that exercise is essential for a resolution of symptoms.
This is demonstrated in several studies showing a 90% resolution with conservative care consisting of corrective exercise .
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What Is It Band Pain And How Do I Fix It
Iliotibial band pain is a condition that causes lateral knee pain . While it is often thought of as an overuse injury because it is common in sports with a lot of repetitive lower body motion , IT band pain can affect anyone.
If youve ever been to the mobility area of your gym, youve likely noticed people trying to stretch their IT band or use a foam roller to massage this painful area on their outer thigh. Perhaps youve even tried doing this yourself. Unfortunately, stretching and foam rolling the IT band is doing nothing to address the root cause of IT band pain on the outside of the knee.
The key to addressing IT band pain in the long term is achieved through 3 steps. First, you must release the tension in the muscles that connect to the IT band, thereby reducing the pull on this area, as well as any other muscles that may be contributing to the issue. Second, you must improve the alignment of your body. Third, strengthen key muscles that support the healthy function of the IT band.
Rest Ice Compression Elevation
Usually most IT band syndrome injuries can be resolved by some simple rest. Although the RICE approach is thought to be most effective in acute, fresh injuries, it isnt thought to be beneficial long-term.2 This is because RICE doesnt address the issues that led to inflammation and injury of the IT band in the first place.
Therefore, if nothing is done to change and remedy the cause then ITBS is likely to crop up repeatedly, although this time it will likely feel worse as it is aggravating a previous injury site. The best way to combat this is to seek the advice of a sports therapist, personal trainer or physiotherapist who will be able to observe and identify the problem at the root of the cause. Check out this blog to find out more natural ways that you can relieve knee pain.
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