Preventing IT Band Syndrome

IT Band Syndrome is one of the most common causes of knee pain in runners. It is an overuse injury caused by repetitive friction of the iliotibial band across the Lateral Epicondyle (see image below). This syndrome presents as lateral (outside) knee pain due to tightness of the ITB and hip abductors. As a result of movement of the band during flexion and extension of the knee and hip, a tight band could be responsible for the inflammation at the knee or even the hip, or along the IT Band.

The main physical causes of this condition are:

• Tight IT Band.
• Altered foot function: Excessively flat feet cause the lower leg to internally rotate excessively, adding a stretch tension to the IT Band.
• Decreased Glute Medius/Maximus function.
• Overactive TFL muscle due to lack of Gluteus Medius function
• A weak or inactive Vastus Medials (VMO). This is the inside muscle group of the quadriceps and tends to become weak on people.
• Medial (inward) knee migration during walking/running.
• Leg length discrepancy.
• Tightness of hamstrings/Quads/Calves

Other non-biomechanical reasons for the condition can be improper running technique, worn-out or improper running shoes, hill running, canted running surfaces, and increasing mileage too fast. If you feel any of the non-biomechanical reasons may be an issue, please confer with your running store or coach.

1-Leg Stance Test for hip/foot/ankle instability      

Gluteus Medius Activation for hip stability

^{Hip instability causing knee inward migration This places excessive stretch on the IT Band}

^{Foam Rolling for IT Band}

From a physical standpoint, the best way to prevent IT Band Syndrome is to correct the causes by performing stretches and exercises to correct any of these above dysfunction. Stretching or foam rolling for the IT band, Hamstrings, Calves and Quads is necessary. Secondly, you need to be evaluated to determine if you have excessively flat arches or excessive pronation of the ankle. If you have flat feet, an orthotic may be beneficial. Lastly, strengthening of the hip stabilizers (glutes) and proprioception training of the ankle are recommended.

If you are, or in the future, suffer from IT Band Syndrome, conservative treatment usually does a great job of freeing you from your pain. In our practice we utilize Active Release Technique (www.activerelease.com), Graston Technique (www.grastontechnique.com) and Kinesio Taping along with other modalities to treat the pain and prevent it from coming back. I recommend you familiarize yourself with the above techniques if you are a runner; they are the top conservative treatment methods running related over-use injuries.

Active Release Technique for Golf Injuries

ART has been developed, refined, and patented by P. Michael Leahy, DC, CCSP. Dr. Leahy noticed that his patients' symptoms seemed to be related to changes in their soft tissue that could be felt by hand. By observing how muscles, fascia, tendons, ligaments and nerves responded to different types of work, Dr. Leahy was able to consistently resolve over 90% of his patients' problems. He now teaches and certifies health care providers all over the world to use ART.

Active Release Technique® (ART) is a patented, state of the art soft tissue system/movement based technique that treats problems with muscles, tendons, ligaments, fascia and nerves. Headaches, back pain, carpal tunnel syndrome, muscle strain, shoulder pain, sciatica, plantar fasciitis, knee problems, and golfer’s elbow are just a few of the many conditions that can be resolved quickly and permanently with ART. As the name implies, ART uses motion to fix the problem. Once the injury has been assessed, the provider uses hands on treatment and patient motion to “free up” the adhesion or restrictions within the muscles, tendons, fascia, etc. These conditions all have one important thing in common: they are often a result of overused muscles, Cumulative Injury.

Cumulative Injury Cycle

The Cumulative Injury Cycle (above) represents the process in which over-use injuries and pain occur. The process begins with Overwork, such as bodybuilding, sports and certain work requirements. This combined with a sedentary lifestyle or repetitive activities leads to Weak & Tight Muscles throughout the body. These weak and/or tight muscles lead to excessive Friction, Pressure and Tension to the local muscles, ligaments, tendons, and fascia. In turn, Decreased Circulation, Swelling and Hypoxia (lack of oxygen) to the area ensues. Due to this hypoxic state, formation of adhesions and/or scar tissue occurs to the area which decreases the function of the local structures. This becomes a vicious cycle that over time results in inflammation, pain and injury.

Implementation of ART to weak or tight muscles with the above mentioned restrictions is necessary for stretches or strengthening exercises to be more effective and in turn correct muscular imbalances. These muscular imbalances are the root cause to many over-use injury and pain syndromes.

Every ART session is actually a combination of examination and treatment. The ART provider uses his or her hands to evaluate the texture, tightness and movement of muscles, fascia, tendons, ligaments and nerves. Abnormal tissues are treated by combining precisely directed tension with very specific patient movements.

These treatment protocols - over 500 specific moves - are unique to ART. They allow providers to identify and correct the specific problems that are affecting each individual patient. ART is not a cookie-cutter approach.