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Conquering Iliotibial (IT) Band Pain Syndrome

Iliotibial (IT) Band Pain Syndrome is a frequently observed overuse injury in individuals who engage in running, cycling, and various athletic activities. This condition frequently manifests as a sharp discomfort along the outer aspect of the knee and tends to worsen with ongoing and repetitive activity. In some instances, it may also result in a clicking or snapping sensation along the outside of the knee.


Anatomy

The IT band is a connective tissue that runs from the outer hip (iliac crest) and extends down the outer thigh, attaching just below the outside of the knee. It plays a crucial role in providing stability to both the hip and the knee joint. The IT band serves as an anchor point for several muscular and soft tissue structures, including the tensor fascia lata (TFL), the gluteus medius and maximus, and the vastus lateralis (the outer portion of the quadricep). Refer to the image below for a visual representation. The well-being and function of all these tissues significantly influence the overall health of the IT band.


WHAT LEADS TO IT BAND PAIN?

There are several contributing factors to the development of IT band pain, often requiring the addressing of multiple deficiencies for symptom resolution. Some of these factors include:

  1. Weakness Deficits

    • Insufficient strength in the glute medius and glute maximus can lead to compromised pelvic control, resulting in instability during activities like squatting, running, and climbing stairs. This instability places added strain on the IT band and, with repetitive motions, can trigger pain.

    • Weakness in the quadriceps can lead to reduced force absorption, placing additional stress on the knee and its surrounding structures.


  1. Mobility Deficits

    • Soft Tissue Mobility: Muscle restrictions around or connected to the IT band are common. Key areas to examine are the gluteal muscles, vastus lateralis (outer quadriceps), TFL, and gastroc.

    • A common issue in individuals with IT band pain is an overactive, restricted, and often tender TFL in combination with an underactive (and possibly weak) gluteus medius. This combination can result in hip and knee collapsing mechanics, which, in turn, can irritate the IT band.

    • Joint Mobility: Two joints that can influence IT band symptoms are the patellofemoral joint and the ankle (talocrural) joint. Inadequate knee cap mobility, particularly in a medial direction, can restrict knee movement and cause abnormal IT band mechanics. Limited ankle mobility can alter gait mechanics, leading to increased foot pronation, collapsing mechanics, and additional strain on the IT band.


  1. Poor Movement Mechanics

    • A comprehensive lower extremity movement assessment can be highly valuable in evaluating overall mechanics during activities like squatting and running. Poor pelvic control can lead to valgus collapse (inward knee drop), while excessive foot pronation can result in valgus collapse from the bottom up. These issues are often exacerbated during running when speed and force increase.


  1. Running Mechanics

    • Sometimes, individuals may not exhibit obvious deficiencies in strength, mobility, or squatting mechanics. In such cases, a closer examination of running mechanics is essential. Even if one has sufficient strength and mobility, it doesn't guarantee their ability to use these attributes correctly in a complex movement pattern. A gait assessment can help identify common deviations that can lead to IT band pain, such as collapsing mechanics, weaving mechanics, and overstriding.


  1. Training Variables

    • The onset of lateral knee and IT band pain can be affected by various training aspects. Rapidly increasing training volume due to higher frequency or intensity can be a contributing factor. Terrain choice is also important; consistently running in one direction on a track or on the same side of a sloped road can irritate the IT band.


  1. Footwear

    • Footwear is another crucial consideration in IT band pain. Wearing worn-out shoes can negatively impact foot, ankle, knee, hip, and pelvic mechanics, contributing to IT band pain. Shoes should not be worn beyond 300-500 miles per pair, and it's often recommended to rotate between at least two pairs. Finding the right type of shoe is equally vital.

    • Rules for selecting the best shoe include:

1) Comfort

2) Neutrality (while adhering to the first rule)

3) No negative alteration of running mechanics

  • The world of running shoes can be overwhelming with numerous brands, models, and changes. If you have questions about the best shoe for you, consult your physical therapist or seek advice from a local running shoe store expert.


WHAT TO AVOID WHEN DEALING WITH IT BAND PAIN?

It's important to note that none of the previously mentioned causes of IT band pain are related to the flexibility, mobility, or tightness of the IT band itself. Since the IT band consists of fascial tissue, it cannot be stretched or foam rolled, nor can it be strengthened. The approach to alleviating IT band symptoms involves addressing the regions above, below, and connected to it to reduce strain on the IT band.

HOW TO EFFECTIVELY TREAT IT BAND PAIN? With the ineffectiveness of stretching or foam rolling the IT band in mind, the question arises: how should we treat and resolve this painful issue?

While there are localized treatments that can provide relief from symptoms, such as laser therapy or TECAR therapy, they do not address the root cause of the pain, potentially leading to its return without additional intervention. Therefore, alongside pain reduction, it is crucial to address any deficits in movement.

Start with mobility! If an individual lacks sufficient range of motion in the knee, patellar mobility, or ankle mobility, they are not adequately prepared for strengthening or making mechanical changes. Similarly, when muscles attached to and surrounding the IT band, such as the TFL, glute medius, glute maximus, and quadriceps, are restricted and either over- or underutilized, they often do not activate or function effectively. Enhancing the mobility of these tissues through techniques like foam rolling, trigger point release, active release methods, or other soft tissue mobilization can quickly improve the activation and function of these muscles, promoting more optimal movement mechanics. *The key takeaway is that no amount of strength or gait retraining can compensate for a mobility deficit.

Once mobility has been properly restored, shift your focus to strength. Without adequate strength, the body lacks the stability necessary to control the substantial range of motion required in activities like running, cycling, and other sports.

Dig deeper! After addressing the fundamental deficits, it's time to concentrate on movement patterns, proper squat mechanics, and gait retraining using movement analysis. This is where you ensure that you are instilling good habits that, ideally, prevent the pain from recurring. It is also vital to discuss and address other aspects of training and recovery, including sleep, nutrition, hydration, and stress. All of these factors can be managed alongside the musculoskeletal deficits being treated. If you need help dealing with IT band pain, schedule your session with our sports physical therapist now by clicking the butting below.




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