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IT Band syndrome is one of the most common injuries that runners face. It will have affected at least one of your running friends at one point or another! The mystery behind this injury can leave many runners frustrated and discouraged with how to get back to what they love. But what if I told you that your pain isn't actually IT Band syndrome?
The truth of the matter is that many people claim to have ITBS when in reality they may just have lateral knee or thigh pain. To understand why this could be the case, let’s look at a picture of the involved structures.
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 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. Instead, focus on rolling out your quads with a lacrosse ball or foam roll.
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. When you truly have IT Band irritation, there is no mistaking it - the area is hot, perhaps swollen, very sensitive, and hurts even to bend your knee slightly. 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.
How are we to differentiate between these conditions? I’ve got good news: we don’t have to! In reality, most people have a combination of symptoms from all of the above. So, in the course of treatment, we look to work on each structure. So, we would treat the underlying issues of why the IT band may be irritated, which may overlap with why there are trigger points in the quadricep, which may overlap with why there are trigger points in tensor fascia latae.
In most situations, these 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, the IT band gets rubbed against your femur, the muscles form trigger points from being overworked, and pain ensues.
It should follow, then, that if we wish to fix these problems, we should seek to make your leg look like the first picture rather than the second! Exercises should focus on hip abduction, hip external rotation, single leg stance, and balance. Exercises to search for could be: hip abduction, single leg squats, single leg balance, single leg deadlifts, step ups, and the like. Specific exercises to suit your unique needs are best assessed in person by one of our highly skilled physical therapists. A comprehensive gait analysis will also be very helpful to see if you need any fixes in form!
If you want to brave the rehab process yourself at first, we have created a DIY IT Band Syndrome program that is on our website and ready for you to start at any time. Check it out, here.
Thanks for reading!
Ryan