IT Band Syndrome
Iliotibial (IT) band pain is one of the most common complaints we see here amongst our runners and triathletes. IT Band Syndrome can present as pain either around the side of the hip or the outer the knee and typically gets worse with repetitive knee bending/straightening activities such as running, swimming or cycling. Most people have tried endless (and painful) foam rolling along their IT bands, but feel they can’t maintain any long term relief. Because the IT band is a thick, taught band of connective tissue, it is nearly impossible to “stretch” and roll out. We’re here to discuss what anatomy is related to this syndrome, what you’re likely feeling, why it happens and what you can begin to do at home that does not include foam rolling. If these strategies don’t do the trick, see our doctors for a more detailed plan of care to address your IT band pain.
Anatomy Review
The IT band is a taught band of connective tissue along the outer aspect of the thigh whose primary action is to stabilize the hip and knee. It attaches to the gluteus maximus and the tensor fascia latae (TFL) at its upper portion and crosses the knee joint down below. It supports the movements of the hip and knee via the actions of these muscles.
What would I feel?
Most people feel dull and achy pain near the outside of the knee often in combination with tightness or pinching near the front of the hip. It is not uncommon for this pain to radiate up or down the outer thigh. This typically feels worse with repetitive knee flexion and extension motions like running, swimming, cycling, squatting, lunging, etc. Additionally, there can be tenderness to touch along any aspect of this structure at the outer thigh, knee or hip. This can make it difficult to lay on either side due to compression of irritated tissues on the affected side or prolonged stretch of irritated tissues on the opposite side.
Why does this happen?
Oftentimes we see IT Band Syndrome as a product of weak, undertrained glutes. When our glutes, which are the primarily stabilizing mechanisms of our hip and pelvis, are not firing or are too weak to do their job, it can lead to compensation through the hip flexor group of muscles. One culprit in particular is the TFL, which is the top portion of that IT band complex. When the TFL remains tight, it tugs on the top of the IT band which can have a painful effect all the way down the side of the leg.
Why aren’t our glutes doing their job? Our glutes can be weak or disadvantaged for a number of reasons. Most patients sit for a majority of the day. They sit to commute to work, sit at a desk, and when work is done, they go for a hike, run, or ride their bike without addressing the tightness that has been building throughout the day. With consistent tightness in the front of the hip, we tend to develop compensatory patterns and our body gets used to recruiting these muscles instead of our largest stabilizing muscles, the glutes. So, prolonged sitting, poor technique with resistance training or running, or lack of training for the back of our body can all be contributing factors to an “unbalanced” hip. Without intentionally working to address this tightness and “re-balance” the forces created by muscles around the hip, we stay in this cycle of over-recruitment and utilization of non-optimal muscles.
What Can You Do To Help?
Stop foam rolling. Loosen the hip flexors. Strengthen the glutes.
Now that we know better, you can save a lot of time and discomfort going directly to the source of the tightness rather than foam rolling on a structure that is not likely to change. We can have greater success addressing tight muscles with elastic properties instead of going right to the IT band.
Addressing the TFL (hip flexor)
Using a lacrosse ball, place the ball against the “front pocket” area of the affected hip (see image above for reference) and lean against it on the wall. You are looking for trigger points. Trigger points are tender, points of tension in the muscle that have a tendency to radiate pain and are “released” with pressure. With that in mind, instead of rolling the ball around on the muscle, sustain pressure on a tender spot for 20-30 seconds. You should feel the discomfort decrease on the tender spot as you hold - this is the “release” of a trigger point. Continue on 3-5 tender spots or as needed. Avoid bony spots or spots that seem to worsen with pressure.
https://www.youtube.com/shorts/BH6U_VXRrxo
Addressing the psoas (hip flexor)
Begin in a half kneeling position on the floor. You will be stretching the side with the knee down. The key to this exercise is first to engage the lower abdominal by drawing the muscles up and in from below the naval, resulting in the tuck of the tailbone. Gently shift forward without losing the lower abdominal engagement to feel a stretch in the front of the hip and abdomen on the side with the leg down. Hold a medium intensity stretch for 30-60 seconds for at least 3 repetitions.
https://www.youtube.com/watch?v=ccRw3WL1u3U
Strengthening - Glutes
1) Hip Bridge with Belt or Resistance Band: https://www.youtube.com/watch?v=BJmCN0hRPC0
Start by lying on your back and your knees bent up to a comfortable position. Begin by engaging your core: draw up and in from below the naval in order to engage the lower abdominal, which will result in the low back flattening to the surface. Exhale all the air from your lungs to feel the ribs shrink down and “corset” the core. This should feel like you’re connecting the upper and lower abdominals. While maintaining this abdominal engagement, squeeze both glutes in order to lift the hips from the surface. Press out with the knees to keep tension in the resistance band or belt. Avoid lifting so high that you lose core activation and begin arching your back. You should predominantly feel your glutes squeezing without activation from the hamstrings or low back. Keep the movement slow and controlled.
2) Hip Abduction: https://www.youtube.com/shorts/o0Eq3oODxXo
Standing with a light resistance band above the knees and the lower abdominal engaged. Stand on a single leg with a soft bend in the knee while the other leg stays straight. Move the straight leg backwards at about a 45 degree angle. Keep the motion small so that you’re sure you’re moving through the hip without compensating and arching through the low back. You should feel that "corner pocket" of the side glute working on both the standing and the moving leg. Keep the movement slow and controlled.
It is important to note that none of these exercises should be painful. Do not continue if that is the case. It is best to consult a doctor if you have continued pain.
In Office Treatment
Chiropractic and Physical Therapy Evaluation for IT Band Pain
If you are suffering from pain down the outside of the leg, in the front of your hip or outer knee, it is likely that you need to have a full evaluation performed by one of our doctors to identify why you are experiencing your symptoms. In your first appointment there will be a thorough examination including a range of motion and mobility assessment, strength testing, neurologic testing, and orthopedic tests related to your symptoms. You will review the examination with your doctor to learn the cause of your symptoms and then will begin treatment to target impairments found upon examination.
Chiropractic care can include any of the following in any combination: adjustments, soft tissue mobilizations, joint mobilizations, Active Release Technique, Graston Technique, Class IV Laser therapy, functional dry needling.
Physical Therapy can include any of the following in any combination: therapeutic exercise for strengthening and/or neuromuscular re-education, joint mobilizations, soft tissue mobilizations, Graston Technique, Class IV Laser therapy, functional dry needling.
Active Release Technique for Pain Relief
Active release technique (ART) is a non-invasive, hands-on diagnostic process of evaluating and treating musculoskeletal problems in the body. ART works by releasing tight and inflamed muscles, ligaments, tendons, and fascia after injury and overuse.
ART is a fantastic tool for releasing the tension in the TFL and other muscles surrounding the hip and knee, which can have a dramatic effect on the pain produced by the IT band.
Dry Needling for Pain Relief
Dry Needling is a technique that uses acupuncture needles to release tight, stubborn, muscles quickly - likely around the knee and hip for IT Band Syndrome. Unlike other hands on techniques, the needle can penetrate deeper into tissues to help manually release trigger points in the muscle and stimulate a healing response. This can be helpful to facilitate pain relief, but also restore muscle length to improve overall muscular function in the muscles that are needled.
Class IV Laser Therapy for Pain Relief
Laser therapy uses specific wavelengths of light (red and near-infrared) to create a warming, therapeutic effect. The light that is transmitted via the laser helps stimulate cellular processes, specifically the production of ATP (adenosine triphosphate), which drives many of the processes within our cells. This increased production of ATP helps speed up the healing process within cells. This kind of laser therapy can also improve nerve regeneration & function as well as impact your cells to increase cell metabolism, enzymatic responses, collagen production, and promote angiogenesis (the creation of new blood vessels). All of these functions help provide relief to symptoms including pain, swelling, and limited range of motion around the hip and knee.
Graston Technique
The Graston Technique is a form of manual therapy known as soft-tissue instrument-assisted mobilization. The general goals of the therapy are to reduce pain and increase muscle function. This is done so through a combination of breaking down the scar tissue and fascia restrictions that are usually associated with some form of trauma to the soft tissue, stretching connective tissue in an attempt to rearrange the structure of the soft tissue being treated, and promoting a better healing environment for the injured soft tissue.
Call or email our office to schedule an appointment for your individualized treatment plan for IT Band Syndrome!