IT (Iliotibial) band and knee pain

Dec 02, 2015

Out of all of the common repetitive injuries out there, IT band pain ranks pretty high on the list. Your iliotibial band (better known as your IT band) is like your youngest sibling growing up, innocent and easy to blame for everything. Yes your IT band hurts when you run, but who is the real culprit here?

I often explain to patients that the source of chronic pain is rarely where the actual problem lies. It takes a village to raise a child right? Well, similarly- it takes many muscles to correctly and efficiently work together to perform a single movement.

Stand on one leg and see how long you can balance for. Is your foot rocking back and forth like a teeter-totter? Does your knee dive inward toward your other leg? Can you see your body literally tilting to one side holding on for dear life before you tip over? These are just a few signs that your lateral stability system could use a tune up.

With every step you take throughout the day, you re-live the one leg stand, at least for a moment. If we don’t have the proper joint mobility and motor control throughout the entire kinetic chain (think head to toe), our movements become dysfunctional, and over time, painful.

So put the foam roller down for a second, and let’s take a closer look at some major lateral line stabilizers:

Core- Quadratus lumborum. These muscles connect from the iliac crest of your pelvis to the 12th rib and transverse processes of each of your lumbar vertebra. Primarily aiding in lateral flexion, these muscles also help to keep your pelvis stable during a one leg stand position.

Gluteus maximus/TFL/Gluteus medius- Together, these muscles are major contributors to a movement called hip abduction. When these muscles contract, the leg moves away from the center of the body. These muscles are so important to help prevent the knee from diving inward toward the other knee during each step.

Adductors- We have 5 different muscles that help to make up what we consider our groin muscles. They help to draw the thigh in towards midline, opposing the movements of the previously described hip abductor muscles (glutes).

The truth is that there are so many other muscles and joints throughout the body that are also involved, but testing and monitoring hip and core strength are great places to start.

Why do you have knee pain??

If these muscles do not work in sync with one another to provide smooth, balanced movement, over time we will develop muscle compensation patterns that may potentially lead to inflammation and pain. The forces are no longer able to be properly absorbed through many of our joints. Overtime, the body becomes irritated and we often are left with chronic overuse injuries such as tendonitis or even arthritis.

It is a common misconception to want to jump on the foam roller in order to stretch out the IT band. The IT band is a tough, fibrous sheath that has almost a zero ability to stretch. And what about runners who have been doing their leg lifts for years, and have adequate hip strength and mobility, but continue to have IT band pain? The answer is you need to look at the whole picture, the entire body from head to toe. Sure, it’s great to re-live Jane Fonda’s glory days, but relying on clamshell exercises as a one-stop-shop to fix your IT band pain is rarely the case.

As a health care provider it is important to understand why a muscle “feels tight and painful” to a patient before we jump in head first to release it. Is that muscle overworking, attempting to help stabilize a specific joint because other significant muscles that help control that movement decided to take a vacation? By foam rolling out a “tight” muscle, you may actually be stripping your body from the one things that it craves, stability. In some cases, this can actually increase your pain and cause your movement patterns to become worse.

Foam rolling or stretching may help you feel better temporarily, but unless you find the weak link in the chain and strengthen it, chances are that IT band pain is going to be sticking around for quite a while. At Arvada Sport and Spine Group, our physical therapists and chiropractors specialize in knee pain and IT band pain. We focus on whole-body movements from head-to-toe that allow us to determine the source of pain faster. This allows our patients to get back to doing the activities that they love faster and more efficiently.

Written by Alyx Brown DC, MS, CCSP

Arvada Sport and Spine Group