If you have been around the running community for any period of time, you have surely heard of the ever-common iliotibial band pain. This is a condition that is quite common, although perhaps not as much as people usually assume. In our youth athletes in particular, this can arise due to growth spurts, changes in strength, and changes in body awareness (proprioceptive)
In order to understand this pain on the outside of the knee, let's look at some anatomy.
As you can see by the above picture, the IT band is a thick band of tissue that runs down the outside of your thigh. To be precise, the IT band is a band of fascia. This band of fascia is connected near your hip to a muscle called tensor fascia latae, which actually means its purpose is to “tense” the IT band! And then the IT band inserts onto your lower leg near your patella and outer shin. But what purpose does this serve? Well, the IT band serves to stabilize your knee against valgus (collapse) and internal rotatory forces. Basically, it assists in keeping your knee from collapsing inward when you are standing on one leg. Oh, and one more thing. This band of fascia is so strong that you can hang a car engine from it without it tearing or stretching (yes, researchers have done this)! So, don’t waste your time “stretching” your IT Band.
So now that we have learned the anatomy and function of the IT band, we should now consider what can happen when things break down. Technically, IT band syndrome is a pain at the lateral (outside) side of the knee. If you were to draw a line from your kneecap over to the side of your knee, this is where the pain should exist for this condition to be diagnosed. It can present with swelling in this area, since a friction of the IT band on the femur can occur. However, most people when they are referring to “IT band pain” it can be hurting anywhere from the knee all the way to the hip. While this is not technically ITBS, it is still a debilitating pain.
You may be wondering, now, what the lateral leg pain could be if it is not ITBS. Well let’s look at some pictures of muscle trigger point referral patterns.
In the first picture, we are looking at the many referral patterns for trigger points in the quad. For our purposes, X marks where the trigger point is most likely to exist, and the red parts show where you would feel pain. As you can see, it would be easy to confuse IT band pain with a trigger point in the vastus lateralis! And then if we look at the second picture, we see that our friend tensor fascia latae can also cause pain that may present like an IT band irritation.
If your knee pain is coming from one of these muscles, rolling out on a foam roll or lacrosse ball can work wonders. When we are rolling tissue out, I want you to be sure that your intensity is not so high that you cannot breathe deeply and relax! If you have to hold your breath due to the pain, it's too much.
In most situations, lateral knee pain issues are all caused by the same problem: a fundamental breakdown in single leg stance stability. Let’s look at these pictures to explain.
In the first picture, note how the runner’s hip, knee, and foot are all in a nice, straight line top to bottom. Everything looks organized and stacked. This is an efficient position! In the second picture, however, notice how the knee collapses in, rotates inward, and the hip drops. This is what we are going to refer to as a dynamic valgus. This means that your musculature is not able to withstand the forces placed upon your body and is now collapsing against the resistance. When this happens, you overwork the tissues on the outside of the hip, leg and knee - which cause this pain! You will often see athletes in mid-growth-spurt demonstrating this gait due to a decrease in strength or stability.
What is the solution to this knee pain? Well, that's pretty straightforward!
- You should be doing some rolling on foam or lacrosse ball to outside of quad and hip (NOT at the knee since there isn't any muscle there)
- You should also add in some strengthening exercises such as my Big Three:
Single Leg Deadlift
(Hint: keep your hips back and don't let your knee come forward)
(Hint: keep all your weight on front leg and just reach back with other)
If you have any trouble getting these exercises to work for you, or your pain just isn't going away, reach out to me for help! email@example.com
Thanks for reading!