Knee Pain in Runners...Could It Be "IT Band Syndrome"?
The "IT band" (aka the Iliotibial band) runs from the hip to the "lateral condyle of the tibia", which is positioned just below the outside region of the knee.
The "lateral femoral epicondyle" is also an important landmark with IT band syndrome, as it is often the friction site of the IT band causing outer knee pain.
The IT band, as it is a tendon (which attaches a muscle to a bone), actually comes from a muscle called the "tensor fascia lata (TFL)". The TFL sits along the outer-front part of the hip. The muscular portion is relatively small compared to the large tendon, but this will be important to know later when we talk about management of the IT band.
What is IT Band Syndrome?
Also known as “ITBS”
Typically manifests as lateral knee pain or pain along the outside region of the knee
Pain is often described as nagging, burning, or sharp
Pain worsens with running or continuation of running
Relieves with rest
Primarily an overuse or repetitive injury that results in irritation and inflammation along the IT band at its attachment site on the lateral condyle of the tibia.
When the knee is bent, the IT band is located behind the femoral epicondyle and it moves forward across this bony condyle when the knee is straightened. There is a sac called a bursa that allows the band to glide smoothly across this bone normally, but should inflammation occur in this area, the increased friction between the IT band and the bone can cause the outer knee pain.
ITBS in Runners
The repetitive motion of running consists of the repetitive bending and straightening of the knee as described earlier. Also as we already discussed, this can cause friction between the bone and the IT band. Studies have described an ‘impingement zone’ occurring at about 30° of knee flexion that occurs during the "initial contact" phase of running as pictured above. During this impingement period in the running cycle, activation of the tensor fascia lata muscle (and other hip musculature) assists the leg with deceleration so that we don’t collapse on it. This generates tension in the IT band and can cause increased friction where the IT band glides over the bone should there be any biomechanical flaws or muscle imbalances such as:
Structural issues (Leg length differences)
Poor or abnormal running pattern
Weak hip/glute muscles
Weak core/poor core control
Poor foot control of the arch especially
Good hip strength BUT poor motor control and coordination of the leg
Management of ITBS
Some rest may be needed initially to allow for reduction of swelling/irritation and allowance of time to address underlying cause of symptoms. During this time, other considerations include:
Running Gait Analysis
Change of running route (running the same route and direction every time can cause “wear and tear” on 1 leg depending on how level or unlevel the road is)
Shoe wear/orthotics evaluation
Physical Therapy Management
Instrument Assisted Soft Tissue Mobilization and/or Cupping
Reduce soft tissue restrictions
Improve soft tissue and fascial gliding
Decrease compression in vulnerable areas
Stretching may or may not be an effective treatment
Some believe that the thick band of tissue that comprises the ITB is one that cannot necessarily be stretched or requires a load to be stretched that is higher than we are able to provide physically
*Foam rolling may be a more effective option, but you want to be careful to avoid further compression to the lateral knee because this is already a compression-inflammation issue
May be more beneficial to foam roll the TFL muscle we talked about earlier
Hip and Core Strengthening/Stabilization
As core/hip weakness and poor lower extremity mechanics are most often the cause for ITBS, implementation of specific exercises to address this is imperative for recovery.
Hip Strengthening (specifically the glute medius and maximus)
Core Stabilization (addressing core stability deficits will translate to improve stability and mechanics down the kinetic chain/YOUR LEGS!)
*Specific exercises will address your specific issues which can be identified upon formal physical therapy evaluation at Redemption Physical Therapy*
Redeem your Health; Redeem your Life!
Written by: Marissa Oxenford, PT, DPT, CF-L1 Trainer