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The Iliotibial Band – more commonly known as the IT Band or ITB – is a thick band of connective tissue that runs from the outside of the hip down to the knee. It helps provide stability at the hip and knee, and also has elastic properties that assist in the gait cycle, but unfortunately can also be a source of pain in the outside of the knee or hip.
Anatomy:
The IT band is not a muscle or a tendon, it is thick fascia- the largest piece of fascia in the body! - which is a sheet of connective tissue. As it is fascia, it does not contract and relax as a muscle does, but experiences changes in tension based on muscles that insert into it – the tensor fascia latae, gluteus medius (via fascia), and gluteus maximus – and based on hip and knee position. The IT band originates at the top of the pelvis, passes over a bony bump on the lateral thigh called the greater trochanter, down past the knee joint, and finally inserts to the proximal tibia at a point called Gerdy’s tubercle.
Dysfunction:
Pain in the lateral hip or knee can occur due to an imbalance of tension between the TFL anteriorly and the gluteal muscles posteriorly. Most commonly, the muscular imbalance seen is overuse and tightness of the TFL, and weakness and underuse of the glutes. We often also see tightness in the vastus lateralis which lies beneath the ITB. In the hip area, this can lead to “snapping” of the ITB over the greater trochanter and irritate the Greater Trochanteric bursa. Distally at the knee, there can be pain over the insertion point of the ITB called Gerdy’s Tubercle, or at the iliotibial bursa. Pain and dysfunction are common in activities like running and cycling which require repetitive bending and straightening of the knee and hip with significant loading, and can especially occur with rapid increases in training volume or intensity. Excessive femoral internal rotation and adduction (meaning that the knee turns inwards and moves towards midline) in the single leg position also puts excessive strain on the ITB insertion. Biomechnical factors such as the feet crossing over during running also results in increased forces on the lateral structures of the leg and can worsen ITB related symptoms.
Treatment:
Since the ITB isn’t a muscle, it really can’t be stretched. I like to think of the ITB as the packing tape that has cords in it – very stiff and not stretchy. Foam rolling over the ITB can help release the vastus lateralis (one of the quadriceps muscles) that lies beneath the band, but doesn’t do much for “loosening” the ITB, while being rather uncomfortable.
Instead, stretching or using a lacrosse ball on the TFL and glutes can be effective in reducing tightness and pain along the ITB. Manual therapy, including soft tissue work, cupping, or trigger point dry needling, can also help reduce areas of tightness or muscular trigger points to help improve symptoms.
It is also important to improve the strength of the glute muscles to normalize tension on the ITB, reduce femoral internal rotation and adduction, and crossover. Two exercises that I like for ITB related pain are the standing clam to strengthen the hip external rotators, and a side plank with hip abduction to strengthen glute med and reduce hip drop.
Initially it may be necessary to reduce the amount of aggravating activities to reduce irritation of your knee or hip. This may mean needing to reduce the volume or intensity of running, cycling, squatting, etc. for a period. After things have calmed down a bit, you can gradually increase training loads to your tolerance, working back to your goal or previous level of function.
Pain caused by IT Band dysfunction can be very frustrating, but can be improved with proper strengthening, biomechanical improvements, and activity modifications. If you are experiencing pain in your hip or knee, schedule an appointment and we can identify areas of improvement strength, gait, and training volume to help you return to your activities!
Thanks for reading!
Dr. Elizabeth Karr PT, DPT