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Treating IT Band Pain

October 1, 2014

About IT Band Pain:

Iliotibial band syndrome (ITBS) is a very common condition, accounting for up to 12% of all running injuries. It can also occur in the non-runner and can be persistent and difficult to resolve. The IT Band is a thick band of connective tissue (fascia) located on the outer thigh, attaching from the pelvis to just below the knee. IT band pain is often located on the outer aspect of the knee, but can be the location of pain anywhere along its course to the hip.

it-band

Anatomy and Function:

Specifically, the IT band has contributions from two muscles: The gluteus maximus and the tensor fascia lata (TFL). These muscles have an important stabilizing role. They both support the pelvis and trunk on the thigh (femur) and stabilize the femur on the lower leg (tibia). They stabilize you while you stand on one leg or shift your weight to one leg. This stability is critical both in walking and even more so when running. If your pelvis and trunk are not stable on the lower extremity, your mechanics can suffer. Any breakdown in stability may lead to pain and dysfunction.

Why does IT Band pain occur?

In the past, decreased flexibility and hip strength have been cited as reasons for IT band pain.  This has resulted in common treatments such as stretching, use of a foam roller, and hip strengthening exercises to address the pain.  While still relevant and effective, these treatments may not fully address the underlying dysfunction and reason for the pain.  A tight IT band is not necessarily a bad thing.  We rely on this structure for stability through its muscular attachments of the gluteus maximus and TFL.

diagramWhile decreased hip strength has been correlated with Iliotibial band syndrome (ITBS), more recent research has pointed to impaired motor control as the culprit (Noehren, et al).  Motor control involves how your body coordinates movements and stabilizes itself through movement.  Faulty mechanics and poor form could be the cause of pain when running or walking. Motor control incorporates stability, balance and strength.

The IT band is often the victim of a bigger problem. Pain in the ITB is often a sign of faulty mechanics above and below and dysfunctional movement patterns. In order to effectively treat IT band pain, you have to be able to identify and treat the source of the dysfunction. Leg length discrepancies may lead to IT band overuse injury of the long leg. These discrepancies can be the result of faulty movement patterns, or could be due to a true length difference at the thigh bone (femur) or leg bone (tibia).

movment-dysfunction

One example of movement dysfunction is valgus collapse. This dysfunction can lead to IT band pain. In valgus collapse, the pelvis drops on the opposite side, the thigh moves inward (hip adduction and internal rotation), the knee moves inward, and the foot and ankle pronate. This can happen as a result of decreased core stability, lower extremity strength and impaired motor control.  Breakdown of control at any part of the chain from the pelvis to the foot can lead to stress on the IT band.

Here is a video showing excessive valgus during jumping.


This is an example of poor motor control.

This video shows excessive hip drop during a single leg squat.

This is another example of poor motor control.

How is ITBS treated?

To treat the cause of ITB pain, it is necessary to address motor control with specific exercises that correct faulty mechanics. These exercises may incorporate core stability, muscle strength, balance, flexibility, and proprioception based on what you specifically need.  Your physical therapist can determine what exercises are indicated to correct your specific impairments. Learning to activate your core and lower extremity muscles and coordinate them appropriately is the key to treating and preventing IT band pain.

Resources

Fairclough, John, et al. “Is iliotibial band syndrome really a friction syndrome?.” Journal of Science and Medicine in Sport 10.2 (2007): 74-76.

Ferber, Reed, et al. “Competitive female runners with a history of iliotibial band syndrome demonstrate atypical hip and knee kinematics.” journal of orthopaedic & sports physical therapy 40.2 (2010): 52-58.

Fredericson, Michael, et al. “Hip abductor weakness in distance runners with iliotibial band syndrome.”  Clinical Journal of Sport Medicine 10.3 (2000): 169-175.

Fredericson, Michael, and Chuck Wolf. “Iliotibial band syndrome in runners.”  Sports Medicine 35.5 (2005): 451-459.

Golightly, Y. M., Hannan, M. T., Dufour, A. B., Hillstrom, H. J., & Jordan, J. M. (2012). Foot Disorders Associated with Over-Pronated and Over-Supinated Foot Types: The Johnston County Osteoarthritis Project.  Osteoarthritis Cartilage  (2010), 1059-74.

Grau, S., et al. “Hip abductor weakness is not the cause for iliotibial band syndrome.” International journal of sports medicine 29.07 (2008): 579-583.
Gray, Henry. Anatomy of the Human Body.  Philadelphia: Lea & Febiger, 1918;
Bartleby.com, 2000.

Kilmartin, Timothy E., and W. Angus Wallace. “The aetiology of hallux valgus: a critical review of the literature.” The foot 3.4 (1993): 157-167.

Miller, Ross H., et al. “Lower extremity mechanics of iliotibial band syndrome during an exhaustive run.”  Gait & posture 26.3 (2007): 407-413.

Noehren, Brian, et al. “Assessment of Strength, Flexibility, and Running Mechanics in Men With Iliotibial Band Syndrome.”  journal of orthopaedic & sports physical therapy 44.3 (2014): 217-222.

Noehren, Brian, Irene Davis, and Joseph Hamill. “ASB Clinical Biomechanics Award Winner 2006: Prospective study of the biomechanical factors associated with iliotibial band syndrome.” Clinical biomechanics 22.9 (2007): 951-956.

Orchard, John W., et al. “Biomechanics of iliotibial band friction syndrome in runners.” The American journal of sports medicine 24.3 (1996): 375-379.

van der Worp, Maarten P., et al. “Iliotibial Band Syndrome in Runners.”  Sports medicine 42.11 (2012): 969-992.