One of the most common pains suffered by runners is discomfort on the outside aspect of the knee, or just below the knee. This can be a very debilitating condition that has stopped people from being able to continue training. It sometimes develops into a “snapping” or clicking on the outside of the knee as well. The gist of the problem is the lower portion of the IT band frictions on a bony prominence particularly when the leg moves from knee flexion (bend) to knee extension (straightening). Many common activities involve bending and straightening the knee repeatedly other than running (cycling, hiking, going up stairs) so this can be a rather common complaint.
The IT band, iliotibial band or tract, as its name implies is NOT a muscles but a thick layer of tissue that envelopes the muscles on the lateral leg . See the green highlighted area in the image.
It is quite dense (ie. it would be challenging to tear) with fibers running in multiple directions resulting in a very strong structure. I like to use an analogy with clients that the IT band is like a tarp let’s say covering your dump items in the back of a pickup truck.. Its job is to secure the items underneath it. It is typically secured with bungee cords or compression straps (these would be your muscles attaching to the band like glute medius and glute maximus and tensor fascia lata). The tarp, alone, can’t hold the items in the truck but the tension created by the straps or bungee cords provides the tightness to the tarp. If one or two bungees are pulled taut but one bungee is slack, the tarp can shift. This is how I visualize the IT band beginning to “rub” when it has the ability to slide forward and backwards because the tension is excessively high from muscles doing too much pulling.
The literature lists a number of “causes” for IT band syndrome or IT band “friction” syndrome. They fall into two categories: Training “errors” or overload and biomechanical faults (ie. quirks in the body’s alignment or structures).
The bad training habits that can bother the IT band are things like running on a camber- ie. on one side of the road so that one leg is lower than the other, or running on a track, never changing the direction of travel.
The proposed biomechanical causes are potentially “bow-leggedness”, high arch feet, a lack of rotation ability of either the femur or the tiba and weakness of key muscles related to tensioning the band (glute medius and multifidus).
Treatment has traditionally focused primarily on reducing inflammation (rest, ice, elevation, compression), stretching and on releasing tension on the band by rolling it and the muscles related to it (quadriceps, hamstrings, glutes, tensor fascia lata) with a foam roller. See the image for my favorite IT band stretch- it takes some know-how to get the right tension, ask me in person if you can’t feel a good stretch, it might require a little adjusting of your position.
Deep tissue massage is also very common. In a recent study weakness of the lateral hip was found in IT band sufferers, more than in normals. With a glute training program 22 out of 24 of the runners in the study were pain free. Here we are again, talking about strengthening the glutes.
So, this is a rather rudimentary and brief outline of IT band issues and resolution. I will say, if allowed to progress for to long, this is a very miserable condition. Because the causes are either in training or in mechanics, this allows much room for correction. Don’t assume you need to “live with” the problem.
Have I missed something you’d like to know about IT band problems? Leave a question in the comments section for me.
Karen Ogilvie, a physiotherapist at our office, also has a favorite stretch for this area- particularly for the tensor fascia lata, which is at the top end of the IT band. Check it out here.
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