Guest Post by: Cristina Nistler
Iliotibial (IT) Band Syndrome can be anywhere from a mild annoyance to a debilitating pain in the side of the knee. The sports medicine community’s understanding of this issue has come a long way over the last 10 years, but some common misconceptions persist and some incorrect terminology still gets used. Below I will explain the anatomy of the IT Band and bust some common myths.
The Iliotibial Band
The Iliotibial Band gets its name from its two attachment sites. It begins on the hip bone called the Ilium and extends down the side of the leg and ends on the shin bone called the tibia. The IT Band is a tough, fibrous tissue. It is not a muscle but it has attachments to several muscles which you can see on the picture above. A small portion of the IT band attaches to the knee cap to help control its motion.
IT Band pain is caused by faulty running mechanics. Some runners experience a movement pattern called “dynamic valgus”. Dynamic valgus means that when they are in motion, the lower body takes on the position you see below:
Because of the IT Band’s 2 attachment sites, it is being stretched during dynamic valgus.
Myth #1: “My IT Band is Tight!”
The IT Band itself is not made up of muscle fibers, so it can not be tight. If it feels tight it is most likely for one of two reasons.
- The muscles that it attaches to are “tight”. I put “tight” in quotation marks here because when people describe a muscle as being tight, it is due to something called hypertonicity. The hypertonicity is usually caused by the muscle being fatigued after having been used quite a bit. This happens very frequently to the muscles attached to the IT Band because all of these muscles are very active in running. If I go for a long run, my quads, hamstrings and glutes will all contract thousands of times. The hypertonicity will apply pressure on all sides of the IT Band and make it feel tight.
- The hip bone is slightly rotated either a little to the front or back. Our pelvis is made up of 7 different bones. In between every bone, there is technically a joint. These joints are not like the joints of the knee or shoulder that are designed to move a lot. However they do need to move just a little bit to allow for things like childbirth. Because of all the muscles that attach to the pelvic bones, they can move a bit during activities like running or baseball pitching. Even a very small amount of movement can change the angle of pull of our muscles and we feel that change.
Myth #2: Foam Rolling and Stretching Will Solve the Problem
For the reasons we discussed above, the IT Band can’t really be stretched in the way muscles can. Furthermore, trying to stretch it can actually worsen the problem because it recreates the mechanism that caused the pain in the first place. Foam rolling alone won’t solve the problem but if used correctly it can be a very important part of the cure.
The key is foam rolling the correct parts of the body – the muscles that attach to the IT Band. This is also an important part of preventing IT Band pain in the first place. Before and after a run, foam rolling the quadriceps, hamstrings, TFL and glutes will decrease the tone in those muscles.
Myth #3: IT Band Syndrome Can’t Be Prevented
OK, I will admit, I don’t know if there is anyone out there who actually thinks this. But I have certainly encountered runners who said things like “I just get…..(insert injury name here)”. It is not inevitable that you have to get IT Band pain every time you train for a long distance. It is not inevitable that it needs to happen to your left leg every track season when you start running in circles every day.
Dynamic valgus can be corrected with specific corrective exercises. If you refer back to the photo above of dynamic valgus, you might notice the following things:
– The person’s non-weight bearing hip is dropping. This means that the gluteus medius on the weight bearing side is weak. This can be addressed with a hip hike exercise.
– The weight bearing knee is internally rotating. Strengthening the muscles that externally rotate the thigh will fix this. Performing a squat with a mini-Theraband around the knee strengthens the external rotators.
– In the photo above, the runner does not appear to be overpronating but this is often a part of dynamic valgus as well. There is a progression of exercises that can be done to support the arch of the foot, the first of which is called “Short Foot”.