Correcting ITB syndrome

Correcting and Treating the causes of ITB syndrome

 

The Iliotibial band or ITB is a long band of connective tissue that runs from the hip muscles, down the outer side of the thigh, crosses over the outside of the knee and attaches onto the top of the tibia bone. Its main function is to stabilise the knee during foot-strike of the gait cycle. ITB syndrome is an inflammatory issue because of a biomechanical dysfunction in the hips.

ITB syndrome is one of the most common overuse running injuries and was said to be caused by friction of the connective tissue rubbing on the lateral femoral epicondyle (the outside bony bit of your upper thigh bone). Recent research has found that it is actually a compression force causing the outer knee pain. It normally just comes on from doing too much training especially hill running and typically hurts more running downhill. During your run, you may find that you are fine in the first mile or two and then you start getting a dull pain in the outside of the knee which gets worse the more miles you do, then the pain gets sharper. Sitting for prolonged periods can also make it worse as when the knee is flexed about 20-30 degrees this is when the ITB is most at risk of compressing on the bony bit of the thigh bone.

IT band syndrome can be due to underactive iliopsoas (hip flexor) muscles. Poor hip flexor function means other muscles have to pick up the slack – TFL (the muscle attached into the ITB) and adductor longus (groin muscle). This happens because the origin of TFL is moved away from the insertion. When running the rectus femoris will take over the role of hip flexion if the iliopsoas is weak.

The gluteal muscles muscles should limit the strain on the ITB when running, however when these muscles are weak, knee valgus occurs. This is when the knee falls inwards due to hip abductor/ external rotator muscle weakness and when running this pain normally occurs when the foot strikes the ground and pain occurs straight after foot strike. The glute max specifically is the most powerful extensor and helps rotate the hip outwards too, whereas the glute medius contributes to a more stabilising role by fixating the pelvis and hip. So when glute medius is not doing its job, you will see the opposite hip drop down, but it’s the standing leg’s glute medius that needs addressing. Another muscle that is not doing its job in fixing the pelvis during the stance phase is the Quadratus lumborum or QL (in the picture it would be the left side helping to keep the right side stable). The external oblique on the same side as the QL will often be inhibited too.  Often blamed to be too “TIGHT” when really it may need activating. This is a  lower back muscle that works to keep the pelvis level during the stance phase.

 

dynamic knee valgus

Dynamic knee valgus is when the knee falls inwards and causes muscular imbalance.

Contralateral pelvic drop is when the opposite hip drops due to glute medius instability on the standing leg.

Contralateral pelvic drop is when the opposite hip drops due to glute medius instability on the standing leg.

 

 

 

 

 

 

 

 

 

 

So when you have weak hip abductors, the body finds other ways to do the movement required and the TFL that is attached to the ITB located around the “pocket” area start to fire and this adds to more pain and compression. ITB syndrome is a common biomechanical issue that needs to be addressed as quickly as possible. Over-striding, heel striking and running at slower speeds can also contribute to ITB pain. So icing the painful area and Gluteal, quads and TFL stretching/ foam rolling can help reduce pain but they won’t fix the issue. That is where you come in and do your hip and core strengthening exercises. To improve this issue quicker, sports massage to the outer quads and acupuncture to the TFL muscle can help increase mobility along with some muscle energy techniques to the hip muscles.

Here are a few exercises worth trying if you are experiencing symptoms, but is always best to go through your symptoms with a health professional first as there can be quite similar but generally if you are getting pain on the outside of the knee and it’s quite sharp when running downhill or going downhill/ downstairs then it’s most likely going to be ITB syndrome.

Side raises with a weight can help stabilise the glute medius. Brace the core to keep the body as straight as possible. Try without weight and do 3 sets of 10 then progress with weight or increase the amount of reps.

Side raises with a weight can help stabilise the glute medius. Brace the core to keep the body as straight as possible. Try without weight and do 3 sets of 10 then progress with weight or increase the amount of reps.

 

Clam shells with band

Clam shells with a band. Raise the leg about 30 degrees whilst bracing the core, do 3 sets of 10 to begin with and progress to 3 sets of 15. You can make it harder by using a stronger band or make it easier by taking out the band.

Gluteus medius strengthening and Eccentric Glute Control exercises should also be implemented into your training program. These exercises will help the external rotators and hip abductors activate better and become strong enough for you to increase your mileage and run more efficiently. To watch videos, click on the highlighted words above.

If you are suffering with IT band syndrome and need it treating, a combination of Sports Therapy techniques such as sports massage to the TFL and outer quads, soft tissue release to the hip muscles and muscle energy techniques to the glutes will relieve you of pain effectively to help you start your recovery better with these exercises!

So what are you waiting for? Get pain-free today at our friendly Cambridge based sports therapy clinic!

 

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