Iliotibial Band Syndrome is a common diagnosis given to runners or lifters who get pain on the outside of the knee or tightness on the outside of the hip when running or squatting. In this post, I will look to uncover some common myths of the IT Band and give you some actionable steps to fixing it. Let's dive in.
The Cause of Pain: Friction or Impingement?
Doctors will blame friction of the IT band during knee flexion & extension because it is believed to slide back and forth over the knee joint causing inflammation to the bursae.
Sorry to say if you’ve been told this, it’s a bold face lie. Why? The IT band does not roll over the femoral condyle because it is anchored firmly by the fascia lata. To put it simply, it is an allusion. Because the positioning changes when you extend and flex the knee. Oh, and there’s also no bursae. There is however a fat pad that is highly innervated. Which when compressed could cause some pain.
How does this work?
As the knee moves from full extension to flexion, compression of the highly vascularized and richly innervated adipose tissue increases between the IT band and lateral epicondyle of the knee, especially in the presence of dynamic valgus collapse (think, knee falls in). The adipose tissue is less compressed in full extension, which may account for the complaints of pain at the outside of the knee during flexion and not full extension with a client with ITB symptoms.
In short, think of IT Band Syndrome more as an impingement syndrome, than a friction syndrome.
That's nice to know, but what if the pain or tightness is higher & closer to the hip? I'm glad you asked.
First, it needs to be said that we should end the notion that the IT Band being “Tight” is a bad thing. It is a dense tissue, developed to laterally stabilize your knee (amongst other things). So, we want it to be tight. Also, even if it does feel "tight", you literally can’t stretch your IT band. Like, you literally can’t do it.
But if you aren’t stretching it, what are you stretching?
Insert the Tensor Fascia Latae aka the TFL. The IT band blends with the TFL muscle near the top of the hip. The TFL is a hip flexor, internal rotator, and abductor of the hip.
It is also a muscle that is in an ideal position to compensate for a lack of mobility and muscular coordination in the hips.
We can also look under the hood of the IT band at the vastus lateralis (your most outside quadricep muscle). The IT band runs over top of this muscle, and when the tibia rotates inwards, this muscle has leverage to hold the femur into this internally rotated position.
Without dragging this out, we can see that it is rarely your IT band that is the issue. It is most likely a more global action happening to the pelvis.
If we are in an anterior tilt, this will drive our femurs into internal rotation. So to “fix” your IT band syndrome, we need to look to restore hip extension first via the glutes and hamstrings. This will in a sense "bring us back" to a more neutral position.
Since the internal rotation that you had at your hip was due to compensation, we should look to restore proper hip internal rotation. This is a great drill to do just that.
Lastly, all the breathing and mobility drills in the world won't fix the issue without load. If load got you into it, then load needs to get you out of it. Insert my current favorite deadlift variation: the staggered stance deadlift.
This more dynamic upright activity will drive you into more internal rotation under load, training the nervous system to "remember" this newly acquired range of motion. You can also go pretty heavy. Win win in my book.
So you see, a lot of times when structures are deemed the cause we need to look deeper into it. Usually, there is an underlying issue that needs to be addressed.
It’s okay to stretch and foam roll, just know you aren’t fixing problems you are just temporarily making them feel a little better.
Tequila never fixed a broken heart, or something like that.