ITBS (iliotibial band syndrome) is a top 10 running injury that is often chalked up to overuse and tightness of the IT band, but if you are someone that has suffered from ITBS, you know that stretching the tissue and decreasing use very rarely seems to help.
Now, you may feel better after rolling your IT Band, but if you have to roll your IT Band every day or stretch every day prior to running, you really aren’t fixing anything, you are simply putting the problem off for another day.
Getting to the root of ITBS can be complex, but much of the problem lies in old outdated treatment approaches that only address symptoms not causes.
What is the IT Band?
The iliotibial band is a band of fascia (not a muscle) that runs from your upper thigh down to your outer knee. The IT Band acts almost like a rope that connects the hip muscles to the knee. At the top of the IT Band, you have the gluteus maximus and the TFL (tensor fascia lata) that are the prime movers while the IT Band is essentially just along for the ride. At the bottom of the IT band is the insertion of the band into the knee region. The knee region is where most of the pain occurs. The glute max makes up approximately 75% of the IT Band and the TFL makes up the majority of the other 25%.
What Not To Do…
- Don’t take painkillers. Painkillers feel good in the short-term but put you at risk for….death. While most people don’t die from painkillers (NSAIDs) it does slow healing. Not to mention by hiding the pain, you only prolong finding the real problem.
- Don’t stretch. Stretching only weakens and elongates a muscle or tissue that is already under stress. If you feel tight, this is a reflection of a muscular imbalance, nervous system overstimulation or lack of strength. For runners this could be lack of crosstraining.
- Don’t ice. Ice will help you deal with the pain, but it only tightens up the area and can decrease local blood flow. The blood flow is needed to help you heal once you identify the root cause.
4 Common Causes and What To Do
1. Fix the Upper Leg Muscles. Since the IT Band is only along for the ride your focus should be on the glute max and the TFL which are the muscles that control the motion and the majority of the tightness and friction of the IT Band. You can do your own trigger point work on the TFL using your thumb. This work is best done by laying on your back and bending your knees to relax the hip flexors. Glute max work is a little harder to do yourself, so using a lacrosse ball to sit and roll on, in order to find trigger points is one way to do it. Anytime you do a posterior muscle in the buttocks region, you should do both the side with symptoms and the side without symptoms. (ex. Piriformis, glute med, glute max, gamelli, etc.)
2. Fix the Lower Leg Muscles. The lower muscles that support the knee are the ones in the calf region. The most common ones I find are the soleus, posterior tibialis and the anterior tibialis. The anterior tibialis is the muscle on the outside of the shin bone. It can be very tender is often the primary or secondary culprit in people that suffer from shin splints. The tibialis posterior is on the inside of the calf just under the shin bone. Both of these muscles should be checked in order to find any tender trigger points and these trigger points can be worked on 3-5 times per day in your spare time.
3. Balance the Knee Left To Right. When the inside of the leg isn’t working properly, the outside suffers and can result in ITBS. On the inside of the knee 3 muscles attach that are related to your adrenal glands. If you are overtraining, doing HIIT, crossfitting, have stress at home/work, or have hormonal symptoms these muscles will not support your knee properly and can lead to the IT band being required to provide excess support. Another inner knee muscle that can cause problems is the VMO. The VMO is the tear drop shaped quadricep muscle on the inside of your leg above your knee. VMO dysfunction is my most common finding with all knee pain. Most therapists used to do leg extensions to try and strengthen the VMO for many knee conditions, but what I find is actually that its not that the VMO isn’t strong enough, but rather that it is too tight, over-contracted or hypertonic. Finding trigger points in the VMO can be one of the fastest ways to relieve knee pain.
4. Shoulder and Back Pain. If you have a history of shoulder and/or back pain, those usually need to be addressed before your knee pain will go away. I won’t go into detail in this article on how treat a shoulder and a back, but its important to know that the back and shoulder (especially the opposite shoulder) must be functioning properly in order for your body to rotate properly and establish an ideal and pain-free gait. In repetitive sports like cycling and running, even minor imbalances can lead to what we term “overuse” injuries, which are really more properly described as chronic muscular imbalance, leading to pain.
If you don’t know how to address adrenal fatigue or are confused about trigger point therapy, then finding a qualified practitioner (preferably one who muscle tests) can be critical to healing. ITBS shouldn’t be a life-long sentence of pain, but rather a symptom of an imbalance that needs to be addressed so that you can perform even better.