How Is The It Band Linked To Knee Pain
Iliotibial band syndrome is a common overuse injury of the connective tissues that are located on the outer thigh and knee. ITBS is also known as iliotibial band friction syndrome because, in theory, it is a form of tendonitis where the iliotibial band can rub painfully over the bone in the side of the knee. However, more frequent research disputes the fact that the iliotibial band even moves at all! Whilst another claims that the IT band does indeed move however it is firmly locked into the side of the knee.1
When the IT band comes closer to the knee it becomes narrower and can result in rubbing between the IT band and the bone causing knee pain. Muscular imbalances or leg length discrepancies can result in ITBS because other areas of the body such as the pelvis have to accommodate for these imbalances. The most common symptom of ITBS is pain on the side of the knee however, this should not be confused with runners knee where the pain is most predominant on the centre of the kneecap.
It occurs when the IT band is tight or inflamed and is a common injury among runners, cyclists and other sports which repeatedly do a squatting action. ITBS often occurs as a result of an activity that causes the leg to turn inwards repeatedly. Iliotibial band syndrome is most likely to occur in women because their hips are often tilted in such a way that the knees can turn in slightly. Tension of the IT band can also be caused by imbalances or weak glutes or fasciae latae .
The Muscles You Should Focus On To Improve It Band Pain
To more effectively treat IT band pain, you should focus your attention on the muscles that directly insert into the iliotibial tract these are the TFL, gluteus medius, and gluteus maximus muscles.
Because we spend so much time sitting down, these muscles are prime candidates for becoming tight and weak, causing them to pull on the IT band. You can improve the health and functioning of each of these muscles through targeted stretching, releasing, and strengthening exercises.
You may even consider adding attention to your main hip flexor muscles, the iliacus and the psoas, due to their function in the body and their relationship with the TFL, gluteus medius, and gluteus maximus that impacts tightness in those areas.
How Can I Reduce My Risk Of Iliotibial Band Syndrome
Preventing iliotibial band syndrome might be difficult if youre an athlete such as a skier, cyclist or long-distance runner. But you might try changing some of the ways you do those activities to reduce your risk of ITBS. Examples include:
- Avoid running up or down a hill or any slanted surface.
- Make sure you have the right technique no matter what activity you do.
- Shift training intensity gradually. Slowly speed up when youre bicycling instead of suddenly switching from slow to fast .
- Slowly warm up and slowly cool down.
- Wear supportive shoes.
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How Does It Band Syndrome Occur
When you bend and extend your leg, the IT band moves over the outer lower edge of your thighbone. But with repeated bending and extending of the knee, this movement of the IT band may irritate surrounding tissues, causing pain in the knees or hips.
Most of the issues we see with the IT band are overuse injuriesrepetitive motioncombined with poor biomechanics, Dr. Hillier said. While poor movement patterns/techniques and being overweight are contributing factors, the unifying cause usually can be traced back to poor muscle balance and strength around the core of the body.
Physiotherapy For Itb Syndrome
Your physiotherapist will carefully assess your knee and plan an individual programme of rehabilitation exercises to help strengthen your knee and leg muscles gradually.
Treatment usually involves manual techniques and stretching exercises at first. Your physiotherapist may suggest you try using a foam roll as part of a home exercise programme to help reduce your pain. Youll then usually need to follow some specific strengthening exercises to help you recover. Finally, your physiotherapist will advise you on how you can gradually get back to your normal activities. Make sure you do the exercises as this is an important part of your recovery.
Your physiotherapist may give you some advice on how to try to prevent the problem coming back. For example, you may need to change your running shoes to correct problems with your foot movement or look at your running gait on a treadmill.
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How Is It Treated
If you closely follow your doctorâs orders and give yourself the rest you need, you can usually recover from it in about 6 weeks.
Some basic steps can help ease the pain and swelling:
- Donât do activities that trigger the pain.
- Take over-the-counter pain relievers.
- Wrap an ice pack in a towel and put it on the outside of your knee for 10-15 minutes at a time.
A physical therapist can:
- Give you tips for how to best warm up and cool down
- Help you choose footwear and, if you need them, shoe inserts
- Show you exercises to help strengthen and stretch your IT band and leg muscles
- Talk to you about how to adjust your training schedule
- Teach you how to improve your form to go easier on your body
- Use friction massage, ice, or ultrasound to help with pain and swelling
That usually does the trick, though some people need cortisone injections to help with pain and swelling.
How Often Should You Do These Knee Strengthening Exercises
If you are doing these exercises as a warm up and/or to treat nagging knee pain, do these exercises before any lower body workout or high impact sporting activities.
If you are rehabilitating after an injury, do these exercises two times a week and closely monitor your comfort level and progress.
Here’s the routine:
Note: For warm up purposes, doing 1 set of each exercise should be enough.
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Shoe Or Orthotic Issues
You can correct every issue in your body, but if what comes between your foot and the ground is the cause of your problem, youll never see relief. Overworn shoes can cause your foot to land at awkward angles, which transfers a lot of stress up to the knee and hip, so keeping your shoes within their recommended mileage is critical. Also, adjusting to minimalist shoes will require you to adjust your running style, so be sure to do your research and be patient while adjusting. Finally, arch or ankle problems may require you to get orthotics so you can run with a safer gait.
With all of these suggestions, you can expect for improvement to take some time. If your pain lingers for longer than a few weeks, it may be time to talk to a healthcare provider for some more individualized treatment.
Treatment For Iliotibial Band Syndrome
The initial treatment for ITB syndrome aims to reduce your pain and inflammation. You can do this with rest and ice and medicines. Further treatment includes physiotherapy to gradually get you back to your usual activities. Most people recover and can go back to sports or running within four to six weeks.
You may find it helpful to see a sports medicine professional, such as a physiotherapist or a sports doctor who can diagnose and treat ITB syndrome. Your GP may refer you, or you can book an appointment with a physiotherapist directly.
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When To See A Medical Professional
See a medical professional at any point if you feel pain, tightness, or discomfort in your leg, especially if its happened suddenly or is persistent.
If youve taken steps to treat your IT band issues and it doesnt seem to be healing, you may want to see a medical professional. You might see a physical therapist, occupational therapist, or osteopath. You can also seek treatment from a chiropractor or a podiatrist.
Exercise 3 Clam Shells With Miniband
Starting position: Lie on your side. Position a miniband between your knee and thigh and bend your knees slightly.
How to perform the exercise: Stabilize your body with your right arm on the floor and then open your knees like a clam. Pull the band apart slowly but firmly and try to engage your hips and core muscles. Let the band pull your legs back together and then repeat the movement again.
Duration: 3 x 10 repetitions per side
As soon as you are pain free for about 10 days, you can try an easy test run. You should keep it short and make sure to warm up well. You can find useful tips and stretches for warming up in this blog post. Its best if you run your test run on a treadmill or do a short, flat loop. This way you can stop at any time if the pain should return again. If everything goes well, you can slowly increase the distance per day. Here you can find some more tips on how to bounce back from a break in your training.
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What Tests Are Done To Diagnose Iliotibial Band Syndrome
Your healthcare provider might perform a test called the Noble and Ober test. There are several steps that include:
- Feeling your lateral epicondyle on the outside of your knee to see if your iliotibial band syndrome pain is coming from that spot.
- Moving your hip away from your body while supporting your knee. You might feel pain and be unable to move your hip very far.
- Moving your knee at different angles to see if that causes pain.
Correct diagnosis of iliotibial band syndrome also requires imaging tests, including:
- Magnetic resonance imaging : Your healthcare provider might order an MRI if they’re unsure about your diagnosis. The MRI should help them with a process of elimination by excluding other injuries like a meniscal tear or a lateral collateral ligament injury.
- Ultrasound: An ultrasound can prove that you have iliotibial band syndrome by showing how your iliotibial band moves when you flex and extend your hip or knee.
How Is Iliotibial Band Syndrome Diagnosed
Your healthcare provider might diagnose you with iliotibial band syndrome after discussing your history of exercise and symptoms and performing a physical examination. Your provider should check for the following signs of ITBS:
- Grating sounds or a grating feeling when your knee or hip moves.
- Pain over the greater trochanter in one or both of your hips.
- Pain at the lateral epicondyle in one or both of your knees.
- Pain that increases the longer you exercise.
- Pain thats worse when you go downhill.
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Why Does Your It Band Hurt
If you have pain in your IT band, trust us: you know.
“The pain is worse with impact-loading, such as when the foot hits the ground during runs, and can feel like a burning sensation. The pain can be surprisingly sharp and persistent,” says Laskowski.
There are a few different potential causes. “IT band pain occurs when the part of the band near the outside of the knee creates friction with the outer aspect of the femur near the knee and causes inflammation,” says Laskowski. The rubbing of the band over your bony bump, combined with repeated flexing and extending of the knee, causes pain on the outer aspect of the knee.
Running is often the cause of IT band pain. “Running on banked surfaces , running downhill, and especially longer distance runs, can all contribute to IT band pain,” says Laskowski.
But it’s not just running that can cause the pain.
“From my clinical experience, Ive seen regional ‘IT band pain’ stem from poor movement patterns, lack of functional hip mobility and control, a lack of ankle mobility, and common overuse injuries with low amplitude high repetition based movements,” says Rusin. Basically, if you have bad form, that increases the risk of IT band pain.
What Exercises Should Be Avoided With Iliotibial Band Syndrome
Most patients recover from iliotibial band syndrome, but it can take from weeks to months to return to full activity without pain. Patience in allowing the body to heal is required for optimal results.
Understanding the importance of symmetry in the body is helpful in preventing iliotibial band syndrome. When activities alter that symmetry, symptoms may occur.
Symptoms may occur in runners who always run in the same direction on an indoor track or who always run on the same side of a banked road. This causes an artificial tilt to the pelvis and increases the risk of developing inflammation and pain. When running indoors, it is wise to change directions when running longer distances. Some tracks have the runners change directions every few minutes while others change direction on alternate days. While running toward traffic is an important safety strategy, finding a way to run on the opposite side of the street safely may minimize the risk of developing iliotibial band syndrome.
Bicyclists are at risk for iliotibial band syndrome if they tend to pedal with their toes turned in , which can cause abnormal stretching of the iliotibial band at the knee. Being aware of pedaling technique and setting the pedals and clips properly may minimize the risk of developing symptoms.
Keeping muscles and other structures stretched is an important part of prevention of many musculoskeletal injuries, including iliotibial band syndrome.
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How Common Is Iliotibial Band Syndrome
Experts note that iliotibial band syndrome often affects U.S. Marines during training. More than 20% get iliotibial band syndrome. Frequent runners, especially long-distance runners, are also prone. Iliotibial band syndrome accounts for about 12% of running injuries. More females than males have iliotibial band syndrome.
Knee pain of which iliotibial band syndrome is one of many causes affects as many as 25% of adults.
Forward Fold With Crossed Legs
Start in a standing position with your feet together. Cross your right leg over your left leg, setting your right foot down to the outside of your left foot. Reach down toward your left foot and breathe deeply. Hold for 30 seconds as the muscle releases.
Do the same with the opposite foot. Repeat five times.
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Preventing Iliotibial Band Syndrome
Although the pain may be felt in the knee, the problem is caused by the muscles that support the knee. Namely the tensor fasciae latae and the large muscle at the rear of your upper leg. Other muscles in the lower back, hip, buttocks and upper leg also affect the function of the knee, so its important to pay attention to all these muscles as well.
Here are some of the things you can do to help prevent iliotibial band syndrome.
- Stretching: To prevent ITBS, it is important that the muscles around the knee and hip be in top condition. Be sure to work on the flexibility of all the muscle groups in the leg, especially the tensor fasciae latae and buttocks. See the videos below for two great ITB stretches for these muscle groups.
Standing TFL and ITB Stretch Stand upright and cross one foot behind the other. Lean towards the foot that is behind the other. If necessary, hold onto something for balance. Hold the stretch position for a minimum of 20 seconds and then repeat with the opposite leg.
Lying Cross-over Knee Pull-down Stretch Lie on your back and cross one leg over the other. Bring your foot up to your opposite knee and with your opposite arm pull your raised knee down towards the ground.
While the recommendations on this page are a good place to start, you’ll get a lot more benefit when you add the right stretches to your training program. With the Ultimate Guide to Stretching & Flexibility you’ll…
Research and References
Why You Should Use Resistance Bands For Knee Pain:
One of the most common pains people experience at some point in life is knee pain. Knee pain can be caused by a number of things including arthritis, inflammation, patellofemoral pain syndrome, osteoarthritis, normal wear and tear, high-impact sports, or injury.
With resistance bands, you can strengthen tendons, connective tissue and muscles surrounding your knees without the hard impact free weight exercises involve. Knee band exercises can improve your knee stability and mobility while also alleviating pain and reducing inflammation.
Knee strengthening exercises with bands are also great for runners and athletes who put a lot of strain on their knees over time. It will ensure their knees are strong and primed for action.
All in all, if you are looking to rehab or strengthen your knees, definitely add these resistance band exercises into your routine.
Note: If you are dealing with an injury, be sure to let it heal before starting these exercises. However, if you simply have nagging knee pain or want to strengthen your knees to prevent pain from occurring, you can start doing these banded knee exercises immediately. If any concern, please consult a medical professional.
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What Kind Of Physical Therapist Do I Need
All physical therapists are prepared through education and clinical experience to treat a variety of conditions or injuries. You may want to consider:
- A physical therapist who is experienced in treating people with orthopedic, or musculoskeletal, injuries.
- A physical therapist who is a board-certified clinical specialist or who has completed a residency in orthopedic or sports physical therapy, as they will have advanced knowledge, experience, and skills that apply to an athletic population.
You can find physical therapists who have these and other credentials by using Find a PT, the online tool built by the American Physical Therapy Association to help you search for physical therapists with specific clinical expertise in your geographic area.
General tips when you’re looking for a physical therapist :
- Get recommendations from family and friends or from other health care providers.
- When you contact a physical therapy clinic for an appointment, ask about the physical therapists’ experience in helping people with ITBS.
- Be prepared to describe your symptoms in as much detail as possible, and report activities that make your symptoms worse.