Are you suffering from pain on the outside of your knee?
One possibility, especially with those running high mileage, could be IT Band Syndrome. This can be irritating to deal with, especially after doing typical at-home treatments such as foam rolling or attempting to stretch the area. Ice can cause temporary relief but how can you fix this?
In the following sections, we’ll dive into what IT Band Syndrome is, why it’s caused, and what you can do about it and make sure it does not come back. Below we have a link if you want to read more on the condition, otherwise, we’ll give you our approach to IT Band Syndrome. https://www.medicinenet.com/iliotibial_band_syndrome/article.htm
What classifies IT Band Syndrome?
IT or Iliotibial Band Syndrome is described as the burning compression of the lower part of the IT Band against the femoral condyle. The IT band starts as an attachment to the gluteus maximus, medius, and tensor fascia latae muscles at the pelvis and continues down to Geordy’s tubercle on the lateral tibia just past the knee. The band also has attachment points along the femur to lessen the bending forces of the femur.
We previously thought it was a friction issue caused by the tendon snapping back and forth over the lateral condyle of the femur, but more recent research shows it is more compression insult with maximal compression at 30° of knee flexion.
Since compression seems to be the issue with this injury, a common misconception is to foam roll your IT band if painful. Not only does this increase the compression on the band which is counterproductive, but we also figured out in a cadaver study that the IT band only stretches .02% with maximal stretch and tensile strength of 7800 psi or pound for pound as strong as soft steel.
There are multiple reasons for this compression that will help us understand how to help you be more effective with your treatment of this syndrome. The two most common causes are improper biomechanics and tight or weak hip muscles.
Improper Biomechanics
Studies have shown a couple of biomechanics flaws can cause increased tensile force on the IT band, therefore causing compression. First, increased knee internal rotation and hip adduction, or in other words knee collapse to the inside of midline, during 3-dimensional motion analysis of runners with IT band syndrome as opposed to the control group.
Another factor in this study was the high arches of the foot being more consistent with the injured group. These factors increase both tensile forces as well as rotational forces across the lateral femoral condyle, creating a potential burning sensation. The lack of proper motion in the foot, or decreased pronation, this forces us to increase the collapse of the knee across the midline, increasing tensile strain.
Tight or Weak Hip Musculature
To add to the cause of improper biomechanics explained above, weak hip abductor and external rotator musculature can also cause the same issue. This can increase the internal rotation of the knee and hip adduction, increasing the tensile and rotational forces of the IT band.
The other problem with hip musculature could be tight hip abductor muscles. With tight muscles on the outside of the hip that attach onto the IT Band. This increases the pull of the IT band from the hip increasing tensile strain down the structure.
How Do We Treat IT Band Syndrome?
Assessment
The first step in treatment is a proper evaluation and history as usual. If you are a runner, this may include a gait analysis to catch biomechanical flaws as indicated above. Our gait analysis includes slow-motion technology of the front and side views of your motion. This allows us to capture even the smallest deviations from an ideal movement pattern. The correction of said biomechanics can be the treatment of the soft tissue, joint restrictions, strengthening certain muscles of the lower half, or cuing corrections of your movement.
The next step in our evaluation would be to assess the joints, soft tissue, and other motor patterns that might help us focus our treatment on key areas. Overall, we do not just take one assessment or answer your history questions and conclude that one thing is the problem. Instead, we use the collection of all our data to come up with a diagnosis, such as in this case IT Band Syndrome.
Phases of Care
The following are the steps we take to treat IT Band Syndrome.
These steps are the following:
Phase 1: Initial Treatment
Phase 2: Soft tissue, Corrective Exercise, and Mobilizations
Phase 3: Return to play
Phase 1: Initial treatment
During the first visit after the assessment, we have to tame the problem. This might be some gentle soft tissue and mobilizations accompanied by E-Stim and Laser. We use this approach to calm the pain down, especially if your condition is acute or in the inflammatory phase. The patient might go home with gentle stretches before we get into the next phase of treatment.
Phase 2: Soft Tissue, Corrective Exercise, Mobilizations
It is important to address soft tissue issues such as myofascial trigger points through techniques such as Active Release Technique or post-ischemic relaxation, which is a muscle lengthening technique using physiological principles to lengthen the muscle, to address these short and tight muscles which may be increasing tension through the IT Band. Also, we might need to strengthen the hip, core, or leg musculature depending on what is weak to prevent this increased insult on the IT band.
Adjustments or mobilizations for this case could include any restricted joint in the hip down to the foot. Since typically there are ridged feet associated with this syndrome, we might look first to adjust the feet. Adjustments to the lower half not only increase needed motion in the joint but allow ourselves to feel where our body is in space through increased proprioception. This can help us become more aware of our knee going into a bad position increasing strain on the IT band.
Phase 3: Return to Play
At this point, we will start to taper you back into running or whatever activity you would like to continue pursuing. We talked about the cuing technique. We try to stay away from this because as the literature states, your best form is most likely your most natural form. So we may not change how you run or move, but if we can add something simple that will not throw off the rest of your biomechanics then we may address it.
The other important factor at this stage is to advance the exercise you were using as a corrective in phase 2. This could be to increase the intensity, frequency, or load. If you continue to advance in our care, we make it a goal to add to your resiliency to further decrease the likelihood of re-injury.
IT Band Syndrome can be an irritating issue to deal with, especially if you don’t know where to start with treatment or if your pain is really this exact issue. If you are dealing with any outside knee pain, we encourage you to call our office and schedule a new patient exam. Our doctors will provide you with the best conservative treatment options for your condition and goals.
